Two major challenges in arthroplasty are obesity and antibiotic resistance. This study was performed to characterise the organisms responsible for deep infection following total hip arthroplasty and to determine if obesity affected the microbiology profile.

A retrospective analysis of the national surgical site infection register was made to obtain data regarding deep infection following 10948 primary total hip arthroplasty (THA) from 1998–2013, with a minimum of 2 year follow-up.

Of all the primary THAs performed, there were 108 deep infections (56 patients had a BMI >30 (obese) and 52 patients <30). There were no significant differences between cardio-respiratory disease, smoking and alcohol status, and diabetes between the 2 groups. Over the last 15 years, staphylococcus aureus continues to be the most frequently isolated organism. Infection with multiple organisms was found exclusively in obese patients. Furthermore, in obese patients, there was a linear increase with methicillin resistant staphylococcus aureus (MRSA) infections and streptococcus viridans.

On this basis, we recommend careful selection of antibiotic therapy in obese patients, rather than empirical therapy, which can be especially important if there is no growth in an infected THA. In addition, a preoperative discussion regarding dental prophylaxis against streptococcus viridans may be warranted.

Anterior knee pain following primary total knee replacement (TKR) is a common problem with average reported rates in the literature of approximately 10%. Symptoms are frequently attributed to the patellofemoral joint, and the treatment of the patella during total knee replacement is controversial.

There is no article in the literature that the authors know of that has specifically evaluated the effect of patella rim cautery on TKR outcome. This is a denervation technique that has historically been employed, with no evidence base. A prospective comparative cohort study was performed to compare the outcome scores of patients who underwent circumferential patella rim cautery, with those who did not.

Patients who had undergone a primary TKR were identified from the unit's arthroplasty database. Two cohorts, who were age and gender matched, were established. None of the patients had their patella resurfaced, but all had a patellaplasty. The Low Contact Stress TKR (Depuy International) was used in all cases.

The effect of circumferential patella rim cautery on the Oxford Knee Score (OKS) and the more anterior knee pain specific Patellar Score (PS) a minimum of 2 years post surgery was evaluated. Previous reports have suggested that a change of 5 points in the OKS represents a clinical difference. A sample size calculation based on an effect size of 5 points with 80% power and a p-value of 0.05 would require a minimum of 76 patients in each group.

There were 94 patients who had undergone patellaplasty only, and 98 patients who had supplementary circumferential patella rim cautery during their primary TKR. The mean OKS were 34.61 and 33.29 respectively (p=0.41), while the PS scores were 21.03 and 20.87 (p=0.87).

No statistically significant differences were noted between the groups for either outcome score. Patella rim cauterisation is unnecessary in primary TKR.

The diagnosis and treatment of hip disease in young adults has rapidly evolved over the past ten years. Despite the advancements of improved diagnostic skills and refinement of surgical techniques, the psychosocial impact hip disease has on the young adult has not yet been elucidated.

This observational study aimed to characterise the functional and psychosocial characteristics of a group of patients from our young hip clinic. 49 patients responded to a postal questionnaire which included the Oswestry Disability Index (ODI) and Hospital Anxiety and Depression Scale (HADS). Median age was 20 years (range 16-38) with a gender ratio of 2:1 (female: male). The most common diagnoses were Perthes' disease and developmental hip dysplasia. More than half of our patients had moderate to severe pain based on the Visual Analogue Scale (VAS) and at least a moderate disability based on the ODI. Thirty-two percent of patients were classified as having borderline to abnormal levels of depression and 49% of patients were classified as having borderline to abnormal levels of anxiety based on the HADS. Comparison of the ODI with the VAS and HADS anxiety and depression subscales showed a significant positive correlation (p<0.05). Multiple regression showed the ODI to be a significant predictor of the HADS anxiety and depression scores (regression coefficient 0.13, 95% confidence interval 0.06 to 0.21, p<0.05).

This study highlights the previously unrecognised psychosocial effects of hip disease in the young adult. A questionnaire which includes HADS may be of particular value in screening for depression and anxiety in young people with physical illness. This study also highlights that collaboration with psychologists and other health care providers may be required to achieve a multidisciplinary approach in managing these patients.