Introduction: Infection is a serious complication of joint arthroplasty. Detection of low-grade prosthetic infection can be difficult, with major implications on the subsequent treatment, cost and patient morbidity. We evaluated the effectiveness of Polymerase Chain Reaction (PCR) in detecting infection in patients undergoing arthroplasty revision surgery.

Methods: Ninety-one consecutive patients (92 joints) undergoing revision THA or TKA were assessed prospectively. Preoperative assessment included clinical examination, blood tests and plain radiographs. At revision, tissue samples were sent for microbiology and histology. Cultures, using blood culture bottles, and PCR were performed on the synovial fluid. Diagnosis of infection relied on the surgeon’s opinion encompassing the clinical presentation, the results of various investigations and the intraoperative findings. Infected arthroplasties underwent a 2-stage revision. Post-operatively patients were followed up at regular intervals for a minimum of 2 years.

Results: Twelve (13%) joints were infected. Histology was positive for infection in 11 cases, tissue cultures were positive in 12 and PCR was positive in 32 cases. Intraoperative tissue cultures had sensitivity 0.75, specificity 0.96, positive predictive value 0.75 and negative predictive value 0.96; histology had sensitivity 0.92, specificity 1, positive predictive value 1 and negative predictive value 0.99 and PCR had a sensitivity 0.92, specificity 0.74, positive predictive value 0.34 and negative predictive value 0.98. At 2 years no patient showed evidence of infection.

Discussion: PCR is a sensitive method of diagnosing prosthetic infection but has poor specificity. False positive results may be due to contamination in theatre or in the laboratory. Positive results in apparently non-infected cases could be due to the detection of low virulence organisms, a small number of bacteria or a strong host immune response. Bacterial fragments and non-culturable forms of bacteria may also be responsible.

Conclusion: PCR was not helpful as a screening test for prosthetic infection. Cultures and histology combined with the surgeon’s clinical judgment remain the gold standard.

The Instructional Lecture will emphasise the advantages of multidisciplinary management for musculoskeletal tumours, which have produced marked improvement in survival rates in the past 10–15 years. The roles and contributions of individual team members in relation to the overall coordinated approach, which can be provided from a single Specialist Centre, or as a managed Clinical Network.

Clinical examples will be used to illustrate the advantages of this approach to the clinical management of these uncommon and challenging conditions. These will include aggressive benign giant cell tumour, malignant osteosarcoma, chondrosarcoma with pathological fracture, and a malignant fibrous histiocytoma of soft tissue.

The Journal of Bone and Joint Surgery published in the A and B volumes remains the premier Orthopaedic Journal of the world. Like other specialist scientific journals it is coming under increasing pressure from the move to more electronic publication on the Internet and the wider availability of freely downloadable information. The need to move to the new technology must be balanced against the needs of the majority of our subscribers, who still require the paper journal, and with the financial requirements of a charitable based not-for-profit publication.

The paper will discuss how these pressures might be met and the plans for the redesign of our website to deliver a wider range of material, including the possibility of electronic pre-prints. The future of the Combined subscription CD-ROM will also be addressed together with the exciting future possibilities offered by the developments in digital information technology.