Increasingly, high flexion components have been touted by the industrial manufacturers of them as the implants of choice for routine total knee replacement (TKR). An acceptable flexion arc is obtainable in most patients through various intra-operative techniques; however, the importance of obtaining high flexion—which we define as greater than 120 degrees—is unclear.

In our pilot study, a review was undertaken involving 60 of the senior authors patients who attained greater than 120 degrees of flexion after receiving an implant said to be high flexion based on the presence of both a rotating platform as well as a conforming cam-and-post third condylar space.

Despite the achievement of both high flexion and impressive patient satisfaction, no functional benefits were observed—an observation that is supported in the current literature. We will explore possible reasons for this discord and note that most patients did not express the desire to regularly perform high flexion activities such as kneeling, squatting and stooping on a daily basis. Our results and evaluation of the literature lead us to question the importance placed upon the achievement of the maximum possible post-operative flexion arc as well as the importance placed in the ability to perform high flexion activities.

This, in turn, calls into question the validity of many of the currently accepted outcomes measures used to post-operatively evaluate total knee replacements.

We describe the experience with the first consecutive 230 Birmingham hip resurfacings at our centre. At a mean follow-up of three years (25 to 52 months) survivorship was 99.14% with revision in one patient for a loose acetabular component and one death from unrelated causes. One patient developed a fracture of the femoral neck at six weeks which united unremarkably after a period of non-weight-bearing. The Harris hip score improved from a mean of 62.54 (8 to 92) to 97.74 (61 to 100). The mean flexion improved from 91.52° (25 to 140) to 110.41° (80 to 145).

Most patients (97%) considered the outcome to be good or excellent. Our preliminary experience with this implant is encouraging and the results are superior to the earlier generation of resurfacings for the same length of follow-up.

Disturbance of lung function during hip arthroplasty surgery is well recognised and, until now, only reported secondary to femoral instrumentation. We present a case report of per-operative acute pulmonary embolism that followed the insertion of an intereference fit acetabular component during hip resurfacing arthroplasty. A subsequent prospective study of per-operative lung function revealed that 9 out of 10 patients experienced an increase in pulmonary shunt value of up to 30% following socket insertion. The changes in shunt values were significant (p=0.009). We have highlighted for the first time the significant physiological disturbances that occur upon insertion of solid interference fit acetabular components, which although apparently transient, may prove life threatening.

A protocol of treatment for acute haematogenous osteomyelitis has been evaluated in 75 children. Intravenous cloxacillin and benzylpenicillin were given in hospital until the child had improved after which oral antibodies and immobilisation were continued at home for a total of six weeks. Oral cloxacillin was used most frequently as Staphylococcus aureus was the major pathogen. Simple drainage of subperiosteal pus was carried out in the 17 children with clinical evidence of an abscess. Ninety-two per cent of the 55 children with acute osteomyelitis diagnosed early were cured by a single course of antibiotics without an operation and with less than one week in hospital. Only 25 per cent of the 12 children with late-diagnosed acute osteomyelitis were cured with a single course of antibiotics and an operation. A longer period in hospital, a prolonged course of antibiotics, and secondary operations were required to cure the other children. Seven (88 per cent) of the eight neonates and infants with acute osteomyelitis were cured with a single course of antibiotics and an operation with only one to two weeks spent in hospital. The remaining infant was cured with a further course of antibiotics. The overall cure rate with a single course of treatment was 83 per cent, and the remaining children were cured with further treatment. More children would be cured with a single course of antibiotics and immobilisation without the need for surgical intervention if treated was started within one or two days of the onset of the illness rather than after four to five days when the disease is more advanced with the formation of and abscess.