Aims: The purpose of this study was to review the success rates of a new management strategy when dealing with deep infection in knee arthroplasty.

Methods: Since 1998 a management plan consisting of an initial debridement, insertion of vancomycin loaded prostolac spacers and 2 weeks of intravenous antibiotics has been used. If inflammatory indices are improved at 12 weeks reimplantation occurs with antibiotic treatment until cultures are completed. The necessary data has been prospectively collected and reviewed to identify predictors of success.

Results: 34 patients have been identified with a minimum of 12 months follow up. 27 of these have at least 24 months follow up. With an endpoint of a functioning prosthesis clear of infection we have achieved an 82% success rate. If the inflammatory indices and frozen section were normal at the time of reimplantation this was 90% predictive of a successful outcome. Although 13 patients had a combination of abnormal blood tests, cultures and frozen sections at the time of reimplantation only 4 of these went on to develop recurrent infection. 2 patients with normal investigations at reimplantation went on to demonstrate residual infection.

Conclusion: Short courses of parenteral treatment can produce comparable results to previously published series when treating deep infection after knee replacement. Allowing weight bearing and range of motion exercise does not appear to hamper the eradication of infection. None of the investigations currently employed have been shown to be 100% reliable in this series of cases. Whilst attention to detail and careful planning are pre-requisites for this surgery one still has to prepared for failure.

Aim: To determine the incidence of non-union of the trochanter and the rate of wire breakage encountered using a trochanteric osteotomy as an approach for primary total hip arthroplasty.

Method: 169 complete records were identified for patients who had undergone hip replacement surgery between 1999 and 2001. The age and sex of the patients, prosthesis used and seniority of the surgeon were recorded. The final position of the trochanter and the state of the wires were determined from the x-rays. An assessment was made of the relationship of the tip of the trochanter to the centre of rotation of the hip both pre and post-operatively.

Results: 169 patients. 98 female and 71 male. 118 cases were performed by consultants and 51 cases by registrars. 76% of cases used an Exeter stem, 16% a charnley elite and 8% a C Stem. The most significant determinant of union was the overall shift of the trochanter. In the healed group the average shift was 5.25mm and in the lifted this was 10.42mm(p=< 0.0001).

The average age of the of the patients that healed was 65.4yrs and 70.06 in those that lifted. Again this was significant (p=0.0078).

There was no correlation between sex of the patient, seniority of the surgeon or the prosthesis type with trochanteric union.

Conclusion: The age of the patient and positioning of the implant have a greater effect on the rate of union than the seniority of the surgeon and the patients sex.

We recommend careful planning pre-operatively to limit the change in position of the trochanter.