Purpose of the study: To ascertain, the Post-operative Joint Infection rates in the Department during 2004.

Methods used and the results: Details of 607 patients were collected. Females were 379(62%) whereas males were 228(38%). Less than 65 years were 133(22%), between 66 and 80 years were 319(53%) and above 80s figure was 155(26%). Total of 197 Primary Hip Arthroplasties (THR) and 190 Knee Arthroplasties (TKR) had been performed. Hip Hemiarthroplasties totalled 137. All the demographic indicators were looked in detail for gender and age range distribution. Revision THRs were 66 whereas 17 were Revision TKRs.

For the purpose of this study, the Revision Arthroplasties were excluded.

Amongst Total Joint Arthroplasties, though 10 patients out of 387 had provided positive results for STAA (Staph. Aureus) from swab specimens, none of the patients developed deep infection. But out of 8, who showed MRSA growth from wound swabs, one patient developed deep infection and needed conversion to Girdlestone procedure. Thus the positive results for wound specimens were 18(4.65%), while the re-operation rate was 1(0.26%).

Conclusion: It is interesting to note that MRSA was prevalent in above 80s while STAA was more common in under 80s. Majority of MRSA positive results were after 30 days while that for the STAA it was before 30 days post-operatively. Of the 18 ‘infected’ cases; Consultants and SAS surgeons had performed 9 cases each.

Amongst 137 Hip Hemiarthroplasties, 25 showed positive growths, 7 for STAA and 18 for MRSA. None needed re-operation.

Interesting revelations on misconceptions are revealed!

Background: Arthrodesis is still the recommended treatment for end-stage hallux rigidus in young and active patients. Silicone implant arthroplasty of great toe was first described back in 1979 by Swanson et. al. Over the years, total joint replacement arthroplasty has taken over, as the apparent complication rate with silicone appeared high.

Objective: The objective of this retrospective study was to analyse medium to long-term clinical outcomes and patient satisfaction of patients with silastic implant arthroplasty of great toe.

Methods: Between May 1996, and December 2004, 65 patients totalling 76 first metatarsophalangeal silastic implants were evaluated both subjectively and objectively. The group comprised of 25 males and 40 females with average age 56 years (26–86). The average time of follow-up was 6 years (2–11). 12 patients (18%) has previous metatarsal osteotomy with bunionectomy for hallux valgus.

Outcomes were assessed by overall subjective satisfaction, Visual Analogue Scale (VAS) for pain, functional scores, range of motion and radiographic evaluation.

Results: Overall success rate was over 80%. 90% patients reported good pain relief after the operation. All patients regained satisfactory range of movement in the joint. The average flexion was 110 (5–200) and extension 200 (10–300). None of the patients reported difficulty in walking or slow running.

6 patients (9%) complained of persisting mild to moderate pain and swelling in the joint. 2 patients (3%) were not happy with the level of deformity correction. All the above 8 patients declined to have joint arthrodesed. 2 patients (3%) had deep infection requiring implant removal. 1 patient had osteolysis on the x-rays but remain asymptomatic. Although radiographic deterioration of the implant was demonstrated in a lot of implants, this deterioration did not correlate with patient satisfaction.

We conclude that silastic first metatarsophalangeal joint replacement is a proven procedure that not only provides long- term pain relief but also satisfactory range of movement. Therefore it should still be considered as an option in patients with end-stage hallux rigidus.