Introduction

Superficial pin site infection is a common problem associated with external fixation, which has been extensively reported. However, the incidence and risk factors with regards to deep infection is rarely reported in the literature. In this study, we investigate and explore the incidence and risk factors of deep infection following circular frame surgery. For the purpose of this study, deep infection was defined as: persistent discharge or collection for which surgical intervention was recommended.

The aims of the study were primarily to establish the overall success of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip replacements (THRs) and secondarily to identify risk factors for failure.

Using a standardised and recognised study protocol (“Meta-analysis of observational studies in epidemiology (MOOSE) guidelines) a systematic review and meta-analysis of the literature was performed. The primary outcome measure of interest was treatment success. The search strategy and inclusion criteria plus quality assessment yielded 39 articles eligible for analysis.

The proportion of success from the literature following DAIR in the management of infected THRs is improving over time – the pooled mean proportion of success is 84.5% in studies from 2011–15. There was improved success with early debridement (75.7%) compared with delayed debridement (48.1%) (p=0.006).

The reported outcomes following DAIR appear to be improving with time. One of the most influential determinants of outcome is timing of debridement from onset of symptoms.

Surgeons should have a low threshold for investigating deep infection when presented with an acutely symptomatic THR and be aware of the updated reported outcomes associated with DAIR when considering management options.

Arthroscopic procedures are increasingly performed for femoroacetabular impingement (FAI). The Non-Arthroplasty Hip Register (NAHR) collects data including the iHOT12 and EQ5D. However there is currently little evidence of its usefulness in assessing hip arthroscopy outcomes. This study aims to assess minimum 1-year outcomes of hip arthroscopy for FAI using the minimum data set (MDS) of the NAHR by comparing these to a patient satisfaction questionnaire.

Pre-operative scores for 78 consecutive hips in 76 patients (43F/33M, mean age at surgery 31.76±10.02 years) undergoing hip arthroscopy for FAI at our institution between February 2013-June 2015 were entered into the NAHR. Insufficient post-operative data was available from the registry. Therefore we collected iHOT12, EQ5D and satisfaction data by postal survey.

Preoperative mean iHOT-12 score was 32.67±14.23, median EQ5D Index score 0.653 (IQR 0.277) and median EQ5D Visual Analogue Scale 70 (IQR 25). Postoperative scores were available for 56 cases (55 patients, 71.8%) at median 18.9 months (IQR 13.77). There was a significant postoperative improvement in self-reported outcome as measured by iHOT-12 (mean improvement 35.7 points, p<0.001) and EQ5DIndex scores (median improvement 0.127, p=0.001). 24 patients were very satisfied, 19 satisfied, 6 neutral, 4 dissatisfied and 1 very dissatisfied. Satisfied patients exhibited greater improvement in iHOT-12 (mean 41.64±19.29 vs 2.8±24.08, p<0.001) and EQ5D index scores (p=0.013) but no difference in EQ5D VAS (p=0.15). Improvement in iHOT12 correlated with improvement in EQ5DIndex (r=0.676, p<0.001) and EQ5DVAS(r=0.552, p<0.001).

Hip arthroscopy for FAI yielded significant improvements in iHOT-12 and EQ5D index scores and 80% of responders were satisfied/very satisfied at a minimum one year postop. iHOT12 and EQ5DIndex correlated with patient satisfaction and improvements in iHOT12 correlated with improvements in general quality of life. Our findings suggest that the MDS of the NAHR is useful for assessing the outcome in these patients.