Presence of superficial wound infection following total joint replacement (TJR) increases risk of deep prosthetic infection and revision surgery. Early identification and management are advocated.

We conducted an audit to identify the number of suspected wound infections, treatment received, and whether diagnosis was supported by microbiological evidence. Early complication data were collected for all TJRs completed in a 12-month period (2012, n=314). Medical records were reviewed for all complications and summarised data were compared with data from 2010/11.

Forty-nine complications were recorded (47 in 2010/11) with increase in number of bacteriologically confirmed wound infections (from 2 to 6) and in number of serious wound infections (n=3).

Review of medical records showed that patients were treated in the community with antibiotics despite lack of objective microbiological evidence. Two of three serious wound infections were preceded by prolonged antibiotic prescription in the community.

Analysis of these results led to a new system for management of suspected wound infection in TJR patients. A ‘wound care card’ is issued at time of discharge and early assessment by a specialist orthopaedic nurse is available. Early results indicate a beneficial effect with potential to improve patient experience and long-term outcome, and to reduce overuse of antibiotics.

Unicompartmental knee replacement (UKR) is associated with higher revision rates than total knee replacement and it has been suggested that surgeons should receive specific training for this prosthesis. We investigated the outcome of all UKR in a district general hospital over ten years.

All patients who had received UKR from 2003 to 2013 were identified from theatre records, as were all revision knee arthroplasties. We contacted all patients (or their GP) with no known revision to ascertain UKR status. A life table analysis was used for three categories: all surgeons and types of UKR, Oxford UKR only and Oxford UKR by surgeons with specific training.

There were 319 UKR (one loss to follow up), four types of prosthesis, 21 failures and a 5-year cumulative survival rate of 91.54%. There were 310 Oxford UKR with 17 failures and 5-year survival 93.56%. Surgeons with training in use of Oxford UKR completed 242 replacements with 10 failures and 5-year survival of 95.68%.

In comparison with results for Oxford UKR in 11th annual NJR report, our results are satisfactory and support continued use of this prosthesis in a non-specialist centre. Our established programme of surveillance will monitor the survival of UKR in our hospital.

The treatment of undisplaced femoral neck fracture in the elderly population is still controversial. We analysed the outcome of cancellous screw fixation for undisplaced femoral neck fracture in patients over 70 years.