Purpose: Approximately, 10% of two-stage TKA revisions for deep sepsis become re-infected. The purpose of this study was to determine the success in terms of sepsis eradication and factors associated with failure of repeat two-stage revision TKA.

Method: Between 1991 and 2006, 129 two-stage revision TKRs for deep sepsis were performed. Ten cases which became re-infected were identified. These unfortunate patients, representing 8% of all the two-stage TKA revisions performed during this time period, are the focus of this study. Their progress and treatment interventions were followed for the purposes of this study.

Results: Ten patients were identified with a two-stage revision TKA which became re-infected. Mean patient age was 72 with 40 % being female. Following recurrent sepsis all patients went on to require more than one further two-stage revision (mean 3.67 further revision surgeries). Infection was only successfully eradicated in 28.7% of cases, the remaining require chronic suppressive therapy or have ongoing active infection. Two patients went on to have an arthrodesis (both remain on suppressive anti-biotics) and one patient had trans-femoral amputation. Staph Aureus and Coagulase neg Staph accounted for 80% of primary infective organisms with only one primary infection with methicillin resistant staph aureus (MRSA). Cultures at subsequent revisions were the same organism in 67% cases. Additional organism cultured included Pseudomonas and Propionibacterium. These patients had an increased incidence of multiple medical co-morbidities including Type-2 Diabetes Mellitus and Rheumatoid Arthritis.

Conclusion: Patients with recurrent sepsis after a two-stage revision for infection in TKR all required multiple further surgeries. Eradication of infection was only achieved in 28.7% cases. Risk factors for recurrent sepsis include Rheumatoid Arthritis and Type-2 Diabetes Mellitus.

Background: Both chemical and mechanical methods of prophylaxis have reduced the the incidence of thromboembolic complications following Total Knee Replacement (TKR). Only a few studies have shown that mobilisation on the first post operative day further reduces the incidence of thromboembolic phenomena.

Aims: We conducted a prospective study to verify not only if early mobilisation but also whether the distance mobilised on the first post-operative day after TKR reduced the incidence of thromboembolic complications.

Methodology: The incidence of deep venous thrombosis and pulmonary embolism were compared in 50 consecutive patients who underwent TKR from July 2006 following a change in the mobilisation protocol with 50 consecutive patients who underwent TKR before the protocol was instigated. The mobilisation protocol changed from strict bed rest the first post operative day to mobilisation on the first post operative day. Mobilisation was defined as sitting out of bed or walking for at least 15–30 minutes twice a day. The distance mobilised was accurately recorded by the physiotherapists. All patients underwent duplex scans of both lower limbs on the fourth post operative day.

Results: There was a Significant reduction in the incidence of thromboembolic complications in the mobilisation group (7 in total) compared to the control group (16 in total) (p=0.03). Furthermore in the mobilisation group the odds of developing a thromboemobloic complication was Significantly reduced the greater the distance the patient mobilised, (Chi squared linear trend=8.009, p =0.0047).

Early mobilisation in the first 24 hours post TKR is a cheap and effective way to reduce the incidence of post-operative DVT.