Propionibacteria are organisms of low virulence, although they do cause deep periprosthetic infections. The aim of this study was to show that Propionibacteria do not always cause a significant rise in ESR and CRP.

Between May 2001 and May 2004, we identified 77 patients with prosthetic joint replacements colonised with Propionibacteria, 47 males and 30 females. There were 47 hip joint replacements, 27 knee joint replacements, 2 endoprosthetic replacements of the femur and 1 shoulder joint replacement. We retrieved successfully the medical records of 66 patients in order to identify the number of patients treated for an infected prosthetic joint arthroplasty. The pre-operative values of ESR and CRP were recorded. For the purposes of this study, an ESR rate of 30mm/hr or higher and a CRP level of 10mg/lt or higher were considered to be suggestive of infection and were deemed a positive result.

All of the 77 patients had both ESR and CRP measured pre-operatively. In only 16 (21%) both ESR and CRP were higher than 30mm/hr and 10mg/l respectively. In 33 patients (43%) with prosthetic joint replacements colonised with Propionibacteria, the pre-operative values of ESR and CRP were normal. 23 patients were treated for an infected prosthetic joint arthroplasty. In 7 (30%) of those patients both ESR and CRP were normal.

This suggests that normal pre-operative values of ESR and CRP in suspected failed prosthetic joint replacements might not exclude infection, if the causative organism is of low virulence such as Propionibacteria.

All patients referred to our unit with previously untreated metastatic renal cancer were included in this review. We investigated likely prognostic factors including age, sex, site, synchronous or metachronous metastasis, stage of the disease and the type of treatment received.

From 1976 until 2004, a total of 198 patients were treated by our unit for renal metastases. 15 patients were excluded because they were referred after failure of previous treatment or only had advice. 96 patients were already known to have renal metastasis with their diagnosis having been made between 0.2 and 17 years from the diagnosis of primary cancer (mean 4 years). 33 patients presented to us with a pathological fracture and were found to have renal cancer. A total of 54 patients had multiple metastases and 129 had a solitary metastasis. The cumulative survival from the time of diagnosis of the bone metastasis is 70 percent at 1 year, 40% at 3 years and 18% at 5 years. In patients with a solitary metastasis, the overall survival was 74% at 1 year and 45% at 3 years, whereas in patients with multiple metastases it was 55% at 1 year and 22% at 3 years. (p=0.02) In patients with a solitary metastasis treated by excision of the metastasis, the survival at 1 year was 86% as compared to 38% for those that were treated with just a local procedure. Cox multivariate analysis shows that survival was better in those with solitary metachronus metastasis who underwent a radical procedure.

Background: Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or postoperatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently, specific indications for the use of the Cell Saver in Anterior Scoliosis Surgery have not been proven. Previous studies have commented on the beneficial aspects of autologous transfusion for Orthopaedic patients in general; However, others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. The aim of our study was to assess and quantify the use of homologous blood, as well as the effects on haematological indices.

Methods: We carried out a retrospective study of 144 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between April 2001 and October 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected.

Results: The median age of the study cohort was 15.0 years (range 8 – 46), and there were 31 males and 113 females. The mean preoperative haemoglobin in patients was 13.5g/dl and the mean postoperative haemoglobin was 10.6g/dl. Haematocrit values followed a similar pattern, the mean pre-op value being 0.41, mean post-op value was 0.29. The range of volume of intra-operatively salvaged cells was 200 to 1100mls. 25 of 144 patients required transfusion. In these patients, the average number of units given was 2.3, although the total homologous transfusion rate was 0.4 units per patient. Results show that homologous transfusion was not required in 82.6% of patients. This is better than previously published rates of transfusion in this procedure. There was no correlation between the number of levels instrumented and the number of units transfused (Pearson Correlation Coefficient 0.19), and no correlation between the number of levels instrumented and postoperative haematocrit values (Pearson Correlation Coefficient 0.16). None of the patients required intra-operative homologous transfusion.

Conclusion: Our experience shows that along with meticulous surgical haemostasis, and hypotensive anaesthesia the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements.

Background The exclusion of infection at the site of a painful or failed prosthetic joint replacement is important for pre-operative planning and counselling. A variety of investigations can be used to assist in the diagnosis or exclusion of infection.

An ESR and CRP are widely used as the initial screening investigation to differentiate between aseptic and septic loosening of prosthetic joint replacements¹. Propionobacteria are organisms of low virulence, although they do cause deep peri-prosthetic infections². We believe that Propionobacteria do not always cause a significant rise in ESR and CRP.

Methods Between May 2001 and May 2004, we identified 78 patients with prosthetic joint replacements colonised with Propionobacteria. There were 48 hip joint replacements, 27 knee joint replacements, 2 endoprosthetic replacements of the femur and 1 shoulder joint replacement. There were 48 males and 30 females. The preoperative values of ESR and CRP were recorded. For the purposes of this study, an ESR rate of 30mm/hr or higher and a CRP level of 10mg/lt or higher were considered to be suggestive of infection and were deemed a positive result.

Results All of the 78 patients had both ESR and CRP measured preoperatively. In only 17 patients (22%) both ESR and CRP were higher than 30mm/hr and 10mg/l respectively. In 33 patients (42%) with prosthetic joint replacements colonised with Propionobacteria, the preoperative values of both ESR and CRP were normal.

Conclusion In our study we have shown that 33 out of 78 patients (42%) with prosthetic joint replacements colonised with Propionobacteria had normal preoperative of both ESR and CRP values. This is to suggest that normal preoperative values of ESR and CRP in suspected failed prosthetic joint replacements might not exclude infection, if the causative organism is of low virulence such as Propionobacteria.

We reviewed our experience with diaphyseal endoprostheses to determine the survival of this type of reconstruction and factors affecting that survival.

Method: We retrospectively studied 44 patients who underwent endoprostheticreconstruction of diaphyseal bone defects after excision of primary sarcomas between 1979 and 2002 with more than 2 years follow up.

Results: There were 27 males and 17 females, the median age at diagnosis was 25 years (8–75) and the median bone defect was 18cm (10–27.6).There were 33 femoral reconstructions, 6 tibial and 5 humeral. The cumulative overall survival for all patients was 67% at 10 years and prosthetic reconstruction using revision surgery as an end point was 62% at 10 years. The cumulative risk offailure of reconstruction including; infection, fracture, aseptic loosening, local recurrence and amputation was 45% at 10 years but for amputation only was 13% at 10 years. The patient age, the type of prosthesis ;whether cemented oruncemented, site of defect (femur, tibia, and humerus) and length of defect did not influence prosthetic survival.

Conclusion: We concluded that the use endoprostheses for reconstruction of diaphyseal bone defects remains a valuable method of reconstruction with predictable results and compares favourably with other forms of reconstruction of massive diaphyseal bone defects.

A compartment syndrome is an orthopaedic emergency which can result from a variety of causes, the most common being trauma. Rarely, it can develop spontaneously and several aetiologies for spontaneous compartment syndrome have been described. We describe a patient with diabetes who developed a spontaneous compartment syndrome. The diagnosis was delayed because of the atypical presentation.