Septic Arthrits & osteomylelitis has traditionally been managed by intravenous antibiotics for 4 to 6 weeks. This requires a prolonged in patient stay, inconvenience to parents, morbidity and unnecessary cost. A number of authors have suggested that shortened course of intravenous antibiotics 7–10 days are effective.

In 2001 we started to prospectively evaluate a shortened 3 day of intravenous antibiotic regime. We prospectively treated 36 cases of acute osteomyelitis and 30 cases of acute septic arthritis in children. These were confirmed by positive blood culture, positive aspirate culture, raised WCC in joint aspirate for septic arthritis or positive bone scan/culture for osteomyelitis. These patients were treated with a shortened course (3 days) of intravenous antibiotics following surgical drainage when required. Serial measurements of inflammatory markers and clinical status were recorded. On Day 4 of admission if clinical and biochemical parameters improved patients commenced high dose oral antibiotics. If no improvement they continued IV abx and consideration for repeat washout given. Patients discharged with three week course of antibiotics. Endpoint analysis of duration of IV administration, inpatient stay, readmission/ reoccurrence was undertaken.

Results: 43 of the 66 (66%) patients received were discharged by Day 5 after receiving 3 full days of intravenous antibiotics. Mean in-pt stay was 5.5 days. There was one re-admission for intolerance of high dose antibiotics. 6 septic patients required a repeat washout (Day 4–7 of admission). At 3 months there were no patients with ongoing infection.

Conclusion: We suggest the vast majority of acute suppurative skeletal infection can be managed safely with shortened course of intravenous and oral antibiotics following surgical drainage (in the case of intra articular infection). About 25% of patients will need longer courses of antibiotics and possibly repeat washout. This subgroup can be identified by careful clinical evaluation and measure

Purpose of study: Septic arthritis and osteomyelitis have traditionally been managed by intravenous antibiotics for 3 to 6 weeks. This requires a prolonged in patient stay, inconvenience to parents, morbidity and cost. A number of authors have suggested that a shortened course of intravenous antibiotics for 7–10 days may be as effective.

This studies reviews the outcomes of a short course regime started in 2001.

Methods: We prospectively reviewed 34 cases of acute osteomyelitis and 28 cases of acute septic arthritis in children. These were confirmed by a positive blood culture or a positive aspirate culture or raised WCC in joint aspirate for septic arthritis; or a positive bone scan/culture for osteomyelitis.

Patients were treated with a 3 day course of intravenous antibiotics, following surgical drainage of joints when required. Providing the clinical and biochemical parameters were improving patients then received 3 weeks oral antibiotics.

The duration of IV administration and of inpatient stay and any incidence of readmission/reoccurrence was noted. Serial measurements of inflammatory markers were recorded.

Results: 35 of the 62 patients received intravenous antibiotics for < 4 days. Mean in-patient stay was 5.5 days. There was one re-admission for recurrence of infection. One patient required a repeat joint washout at 7 days. At 3 months no patients had ongoing infection. There was a correlation between CRP levels and the severity of infection, and therefore the length of treatment required.

Conclusions: We suggest acute suppurative skeletal infection can be managed safely with a shortened course of intravenous and oral antibiotics (following surgical drainage in the case of intra articular infection). Patients must be observed closely by experienced practitioners.

Weight gain is often reported by patients who succumb to impaired activity as a result of progressive osteoarthritis of the hip or knee. Optimistic views of weight loss after joint replacement are often held by patients. We studied the affect of lower limb arthroplasty on body weight.

We reviewed 144 patients having undergone hip and knee arthroplasty and were functionally well. Infected cases were excluded. Average age was 65 years and average follow up was 27 months. The Body Mass Index (BMI) was prospectively measured at follow up and compared to immediate pre-operative BMI.

Our findings demonstrated an average rise in BMI post-operatively which was statistically significant. A rise in post operative BMI was seen in patients who were obese to start with or those who had undergone a total hip replacement (statistically significant). Moderate rises were seen in patients who had underwent hip resurfacing procedures or those who were overweight preoperatively (p=0.06).

These findings are useful in informing patients of achievable expectations following joint replacement surgery and preoperative overweightness should be treated as a separate entity unrelated to co-existing joint degeneration.

Introduction: Difficulties posed in managing late diagnosed CDH are a high placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is now well-established practice. Femoral shortening prevents excessive pressures on the enlocated femoral head which can predispose to avascular necrosis. Instability due to a co-existing dysplastic shallow acetabulum is frequent and so a pelvic osteotomy is performed to achieve stable and concentric hip reduction.

Theoretical advantages of a one stage open reduction includes shortened hospital stay, avoidance of prolonged repeated immobilization and decreased joint stiffness. This study reports the results of single stage combined procedure for late presenting congenital dislocation of the hip in children aged 4 years and above.

Methods: We retrospectively reviewed 15 patients (total 18 hips) presenting with CDH age 4 years and above who were treated by one stage combined procedure performed by the senior most author. The average age at surgery was 5 years and 9 months (range 4 years to 11 years). The average follow up was 6 years 2 months (range 2 years to 8 years 6 months). All patients were followed up clinically and radiologically in accordance with McKay criteria and modified Severin classification.

Results: According to the McKay criteria12 hips performed excellently whilst 6 did good. All patients had full range of movement except for one. There was an average 1 cm limb length discrepancy in 8 patients. All were Trendlenburg negative. Modified Severin classification demonstrated 4 hips of grade1a, 6 were 1b, 8 were grade 2. 1 patient had AVN and 1 had subluxation requiring revision surgery.

Conclusions: In conclusion, one stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in short to medium term follow.

Difficulties posed in managing developmental dysplasia of the hip diagnosed late include a high-placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is a well-established practice. Femoral shortening prevents excessive pressure on the located femoral head which can cause avascular necrosis. Instability due to a coexisting dysplastic shallow acetabulum is common, and so a pelvic osteotomy is performed to achieve a stable and concentric hip reduction. We retrospectively reviewed 15 patients (18 hips) presenting with developmental dysplasia of the hip aged four years and above who were treated by a one-stage combined procedure performed by the senior author. The mean age at operation was five years and nine months (4 years to 11 years). The mean follow-up was six years ten months (2 years and 8 months to 8 years and 8 months). All patients were followed up clinically and radiologically in accordance with McKay’s criteria and the modified Severin classification. According to the McKay criteria, 12 hips were rated excellent and six were good. All but one had a full range of movement. Eight had a limb-length discrepancy of about 1 cm. All were Trendelenburg negative. The modified Severin classification demonstrated four hips of grade IA, six of grade IB, and eight of grade II. One patient had avascular necrosis and one an early subluxation requiring revision.

One-stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in the short to medium term.

Introduction: We have investigated the accuracy of a serological marker to distinguish between septic and aseptic loosening of Total Hip Replacements (THR). We present the preliminary results of our on-going prospective study.

Methods: After obtaining Ethical Committee approval, 46 patients were collected in 3 groups; “control” primary THR, revision THR for aseptic loosening, and revision THR for infection. Serum IgG responses to an exocellular bacterial antigen (Lipid S) were determined by enzyme-linked immunosorbent assay (ELISA).

Results: Our results show that the test can accurately differentiate between the patients with infected joint replacements and the control group. The test, to date, has a specificity of 93% and a sensitivity of 100%.

Discussion and Conclusion: This simple and cheap test can reliably assist in the accurate evaluation of a painful hip arthroplasty, and planning for revision surgery. It will also be useful in the management of patients in whom the microbiology results are either negative or based on a single isolate of an organism, which may be either a contaminant or a possible pathogen. This, in turn, would have implications on financial costs and the optimum use of available resources.

Introduction and Aims: We have investigated the accuracy of a serological marker to distinguish between septic and aseptic loosening of Total Hip Replacements (THR). We present the preliminary results of our ongoing prospective study.

Method: After obtaining Ethical Committee approval, 46 patients were collected in three groups: ‘control’ primary THR, revision THR for aseptic loosening and revision THR for infection. Serum IgG responses to an exocellular bacterial antigen (LipidS) were determined by enzyme-linked immunosorbent assay (ELISA).

Results: Our results show that the test can accurately differentiate between the patients with infected joint replacements and the control group. The test, to date, has a specificity of 93% and a sensitivity of 100%.

Conclusions: This simple and cheap test can reliably assist in the accurate evaluation of a painful hip arthroplasty, and planning for revision surgery. It will also be useful in the management of patients in whom the microbiology results are either negative or based on a single isolate of an organism, which may be either a contaminant or a possible pathogen. This, in turn, would have implications on financial costs and the optimum use of available resources.

Introduction: We have investigated the accuracy of a serological marker to distinguish between septic and aseptic loosening of Total Hip Replacements (THR). We present the preliminary results of our on-going prospective study.

Methods: After obtaining Ethical Committee approval, 46 patients were collected in 3 groups; “control” primary THR, revision THR for aseptic loosening, and revision THR for infection. Serum IgG responses to an exocellular bacterial antigen (Lipid S) were determined by enzyme-linked immunosorbent assay (ELISA).

Results: Our results show that the test can accurately differentiate between the patients with infected joint replacements and the control group. The test, to date, has a specificity of 93% and a sensitivity of 100%.

Clinical Relevance: This simple and cheap test can reliably assist in the accurate evaluation of a painful hip arthroplasty, and planning for revision surgery. It will also be useful in the management of patients in whom the microbiology results are either negative or based on a single isolate of an organism, which may be either a contaminant or a possible pathogen. This, inturn, would have implications on financial costs and the optimum use of available resources.