Bacterial infection in orthopaedic surgery can be devastating, and is associated with significant morbidity and poor functional outcomes, which may be improved if high concentrations of antibiotics can be delivered locally over a prolonged period of time. The two most widely used methods of doing this involve antibiotic-loaded polymethylmethacrylate or collagen fleece. The former is not biodegradable and is a surface upon which secondary bacterial infection may occur. Consequently, it has to be removed once treatment has finished. The latter has been used successfully as an adjunct to systemic antibiotics, but cannot effect a sustained release that would allow it to be used on its own, thereby avoiding systemic toxicity.

This review explores the newer biodegradable carrier systems which are currently in the experimental phase of development and which may prove to be more effective in the treatment of osteomyelitis.

Introduction: Trochanteric bursitis (TB) in association with increased femoral offset components in THA has not previously been reported. We report 15 cases of postoperative TB, all of whom were noted to have high offset femoral implants. Increasing awareness of this complication when inserting femoral components is an important consideration for the arthroplasty surgeon, emphasizing the need for preoperative templating.

Methods: We retrospectively reviewed casenotes and postoperative radiographs patients attending outpatients following THA, with lateral hip pain. A diagnosis of trochanteric bursitis was made in individuals complaining of lateral hip pain, worse on exercising, and tenderness over the trochanter. The presence of a high offset femoral component was noted from casenotes radiographs. Patients with pre-existing TB, recent local trauma, or inflammatory disease which may contribute to TB, were excluded.

Results: 15 cases were identified in a 3 year period. Female to male ratio 1.3:1. The mean age was 68 yrs with a range of 54–81yrs. 7/15 cases (46%) underwent posterior approach to the hip, 8/15 (54%) underwent a Hardinge lateral or modified lateral approach. All patients had clinical features of TB at first postoperative follow up. Mean time to onset of symptoms was 7.2 months, range 2–12 months. All femoral implants had 5mm offset or greater. Postoperative X-rays showed a mean increase in offset of 10.2mm, range 3–18mm.

Discussion: The results indicate that an increase in femoral offset may increase a patient’s risk of trochanteric bursitis, following THA. The data suggest the operating surgeon should consider carefully the use of increased-offset implants, particularly in those at a higher risk or TB e.g inflammatory disorders. This study emphasises the importance of preoperative templating in total hip arthroplasty.