Septic Arthritis is an important life threatening condition affecting all age groups with a mortality of up to 11%. Our aim was to perform a study of the demographics, length of stay, complications and investigate if time delay of surgical treatment from the time of diagnosis has an impact on mortality and morbidity of the patients. We performed a retrospective study of all the patients presented to our Hospital between 2005 and 2009 with septic arthritis who underwent arthroscopic lavage as definitive intervention. We excluded the patients involving minor joints. Data collection was performed from case notes, microbiology and haematology laboratory results. We divided the patients into three groups based on the time from diagnosis to arthroscopic lavage as T1 (less than 12 hours), T2 (12–24 hours) and T3 (more than 24 hours). Our primary outcome measures were mortality and complications such as Intensive Care Admission. Secondary outcome measures included average length of stay in each group. A total of 57 patients were evaluated. The average age of the patients was 49.7 (10 months–94 years). 2 patients of T1 group died (5.4%) 3 patients of T1 group needed Intensive Care Unit (ICU) management (8.1%). There were no deaths or ICU admissions in the other groups. 40.3% of patients needed arthroscopic lavage more than once. The average length of stay of T1 was 19.8 days, T2–11.5 days and T3–27.5 days. Majority of the joints involved were knees (63.1%).23 patients (40.3%) had a preceding intervention performed in the same joint. Staphyloccus aureus was the most common organism isolated in 14 patients (26.3%).Methods
Results
There are a growing number of younger patients with developmental dysplasia of hip, proximal femoral deformity and osteonecrosis seeking surgical intervention to restore quality of life, and the advent of ISTCs has resulted in a greater proportion of such cases being referred to existing NHS departments. Bone-saving hip athroplasty is often advocated for younger active patients, as they are potential candidates for subsequent revision arthroplasty. If resurfacing is contraindicated, short bone-conserving stems may be an option. The rationale for short stems in cementless total hip arthroplasty is proximal load transfer and absence of distal fixation, resulting in preserved femoral bone stock and avoidance of thigh pain. We have carried out 17 short stem hip replacements (Mini-hip, Corin Medical, Cirencester, UK) using ceramic bearings in 16 patients since June 2010. There were 14 females and 2 males, with a mean age of 50.1 years (range 35–63 years) at the time of the surgery. The etiology was osteoarthritis in 11, developmental dysplasia in 4, and osteonecrosis of the femoral head in one patient. All operations were performed through a conservative anterolateral (Bauer) approach. These patients are being followed and evaluated clinically with the Harris and Oxford hip scores, with follow-up at 6 weeks, 3 months, and annually thereafter. Initital results have been encouraging in terms of pain relief, restoration of leg length (one of the objectives in cases of shortening) and rage of movement. Radiological assessment has shown restoration of hip biomechanics. Specific techniques are required to address varus, valgus and femoral deformity with leg length inequality. There are two main groups of short stems, those that are neck-preserving and those that do not preserve the femoral neck. The latter group requires traditional techniques for revision. Another feature that differentiates them is the availability of modularity. The device we employed is neck-preserving and available with different neck lengths and offsets, which help in restoration of hip biomechanics. The advantage of such short stems may be preservation of proximal femoral bone stock, decreased stress shielding and the ease of potential revision. Such devices may be a consideration for patients with malformations of the proximal femur. Long-term follow-up will be of value in determining if perceived benefits are realised in practice.
Compare the prevalence of psychological distress in claustrophobic patients compared with a non-affected group, together with determination of presenting disability and overall intervention rates. Retrospective case notes review. 33 patients (13 males) all requiring MRI scan under sedation for claustrophobia (Group 1) were compared with an age and sex matched cohort that had MRI without sedation (Group 2). Both groups were drawn from the same chronic back clinic. Average age in both groups was 54 years (range 27-79 years). Both groups had standard conservative therapy, together with psychometric evaluation. Primary: Zung Depression Index (ZDI), Modified Somatic Perception Questionnaire (MSPQ). Secondary: Oswestry Disability Index (ODI), intervention rates (surgery, injections and physiotherapy sessions) Comparison of means - 22 patients (66.7%) in Group 1 were discharged after their MRI with no intervention compared to 7 patients (21.2%) in Group 2. Claustrophobic patients with back pain showed higher levels of depression than non-claustrophobic patients, with a greater prevalence of psychological distress. Disability however was the same. The majority of claustrophobic patients had no intervention, with a lower rate than their non-claustrophobic peers. Claustrophobia is a proxy for psychological distress and should be considered in the overall evaluation of chronic back patients.
