Introduction: Hot swollen knee joints are a common presentation in clinical practice. It has wide differential diagnoses, the most serious being septic arthritis. Delayed or inadequate treatment leads to joint damage. Arthroscopic lavage should be planned appropriately after proper clinical assessment and investigation. Other differential diagnoses like crystal arthritis, reactive arthritis, monoarticular inflammatory arthritis should be considered.

Patients and Methods: This retrospective audit involved 44 patients who had arthroscopic knee lavage for suspected septic arthritis from January 2005 to May 2007. Analysis included the aspects of adequate backup supportive evidence for the procedure, the time from diagnosis to operation and postoperative antibiotic regime.

Results: There were 29 males and 15 females with age group ranging from 11 to 91 yrs. Fever was present in 15 patients(34%), preoperative joint aspiration done in 22(50%), peri-operatively pus found in 11(25%). 13 patients(29.5%) had procedure done within 6hrs, causal organism identified in 25%. Follow-up ranged upto 12 months without persistence or reactivation.

Discussion: Arthroscopic lavage is a useful adjunct in treatment of septic arthritis of knees but proper patient selection with systematic approach considering other possible differential diagnoses is important for avoiding unnecessary operations.

A review of the outcome, safety, practicality and cost effectiveness of day surgery anterior cruciate ligament (ACL) reconstruction was studied in the British set-up.

From January 2003 to May 2005, 75 patients who underwent day case arthroscopic ACL reconstruction without the use of tourniquet or nerve blocks, but using a pump-regulated saline-epinephrine irrigation system were studied prospectively. 68 patients had a hamstring tendon graft and 7 patients had patellar tendon graft reconstruction. None of the patients required overnight stay. Mean immediate postoperative Visual Analogue Score (VAS) for pain was 2.5 (range1–8) and 0.5 (range 0–3) at 6 weeks indicating excellent pain control. The mean follow-up was 14 months (range 6–30 months). We had no early or late complications in this series. ACL specific Mohtadi Quality of Life Index improved from pre-operative score of 20 (15–40) to 93 (80–100) at 9 months after surgery. The mean Modified Lysholm Knee Score was 93.9 points, (range 80–100) at the 9 months follow-up examination. On Tegner activity score, 68 patients returned to the same level of sporting activity at 8 months and the rest 7 patients dropped 1 level. The average saving per patient was in the range of 50–60% when compared to inpatient ACL reconstruction.

In conclusion, day case ACL reconstruction using a pump-regulated saline-epinephrine irrigation system is safe, cost-effective and is the patient’s choice.

To determine the ten-year survivorship of the Original M E Muller Straight Stem Total Hip Replacement System with emphasis on the longevity of the femoral component in accordance with guidelines published by the National Institute of Clinical Excellence, 266 consecutive hip arthroplasties using the above prosthesis were performed by the senior author between 1983 and 1992. 24 patients were lost to follow-up. Of the remaining 242 patients 80 were male and 162 female. The mean age was 67.49 years. The diagnosis for the majority of patients was osteoarthritis of the hip joint. Pre-operative planning was carried out and the patients were scored using Charnley’s modification of the d’ Aubigne and Postel numerical grading system A mono-bloc stem with a 32-millimeter head used via the trans gluteal approach recommended by Muller. Following discharge serial follow-up consisted of both clinical and radiological evaluation. The data was prospectively stored on a Microsoft access database. The survival of the prosthesis using revision for aseptic loosening as an end-point was calculated by actuarial analysis.

135 patients attended their ten-year follow-up. 97% of patients had good to excellent pain relief and improvement in movement of the joint following surgery. 38% had good to excellent mobility with the remaining having restricted mobility due to associated co-morbid factors. Only in 3% of patients was mobility restricted as a result of the arthroplasty. 7 revisions were carried out for aseptic loosening, all as a result of failure of the acetabular component. The cumulative survival for this hip replacement system was 95.9% and that for the femoral component was 100% at 10 years.

The Muller Straight Stem femoral component is based on a press-fit concept and gives predictable long-term results when recommended surgical technique is followed. This series confirms the reliability of the stem design and satisfies the NICE guidelines.