Bone loss involving articular surface is a challenging problem faced by the orthopaedic surgeon. In the hand and wrist, there are articular defects that are amenable to autograft reconstruction when primary fixation is not possible. In this article, the surgical techniques and clinical outcomes of articular reconstructions in the hand and wrist using non-vascularised osteochondral autografts are reviewed.

The fracture most commonly treated by orthopaedic surgeons is that of the distal radius. However, as yet there is no consensus on what constitutes an ‘acceptable’ radiological position before or after treatment. This should be defined as the position that will predict good function in the majority of cases. In this paper we review the radiological indices that can be measured in fractures of the distal radius and try to identify potential predictors of functional outcome. In patients likely to have high functional demands, we recommend that the articular reconstruction be achieved with less than 2 mm of gap or step-off, the radius be restored to within 2 mm of its normal length, and that carpal alignment be restored. The ultimate aim of treatment is a pain-free, mobile wrist joint without functional limitation.

We have reviewed the literature to establish the role of lateral retinacular release in the management of disorders of the extensor apparatus of the knee. The scientific evidence for intervention is explored and reports on outcome are discussed.

Fractures of the proximal interphalangeal joint include a wide spectrum of injuries, from stable avulsion fractures to complex fracture-dislocations. Stability of the joint is paramount in determining the appropriate treatment, which should aim to facilitate early mobilisation and restoration of function.

Introduction: Surgical site infection following total hip replacement results in poorer outcomes, longer hospital stays, and increased costs. The aim of this study was to describe infective complications in a large series of total hip arthroplasty.

Methods: Between January 1998 and March 2005, consecutive total hip arthroplasties were prospectively. The presence of deep infection was confirmed by culture from joint aspiration or a secondary procedure such as joint washout or component removal and replacement. Risk factors for development of surgical site infective complications were analysed.

Results: 2029 consecutive total hip arthroplasties was carried out in 1539 patients. There were 22 deep infections (1.1%) and 118 superficial infections (5.8%). Staphylococcus aureus (MSSA) was isolated in 10/22 (45%) of deep infections and MRSA in 4 (18%). In patients undergoing unilateral replacement there were 11/1539 deep infections (0.7%) compared 5/172 (2.9%) in the bilateral simultaneous group. In patients who were current or exsmokers the deep infection rate was 11/880 (1.3%) compared to 7/864 (0.8%) in non-smokers. 3/120 (2.5%) diabetic patients developed deep infection. In patients who received a blood transfusion 9/502 (1.7%) developed deep infection compared to 13/1527 (1%) who did not. In patients with a BMI> 35kgm⁻² the overall rate of infective complications (superficial and deep) was 18.8%. In patients with a report of a perioperative complication the deep infection rate was 6/169 (3.6%) compared to 16/1860 (0.9%) without complication.

Discussion: This study has the advantage of investigating infective complications in a typical case series of patient presenting for total hip replacement. The rate of deep infection was consistent with previous reports. Deep infection is associated with bilateral simultaneous replacement, smoking, diabetes, blood transfusion and perioperative complications. Obese patients are at higher risk of all surgical site infective complications.

We have evaluated the quality of life and functional outcome after unilateral primary total hip replacement (THR). Between 5 January 1998 and 31 July 2000, we recruited a consecutive series of 627 patients undergoing this procedure and investigated them prospectively. Each was assessed before operation and reviewed after six months, 18 months, three years and five years. The Short Form-36 Health Survey (SF-36) and Harris Hip scores were evaluated at each appointment.

All dimensions of the SF-36 except for mental health and general health perception, improved significantly after operation and this was maintained throughout the follow-up. The greatest improvement was seen at the six-month assessment. On average, women reported lower SF-36 scores pre-operatively, but the gender difference did not continue post-operatively. The Harris Hip scores improved significantly after operation, reaching a plateau after 18 months. The improved quality of life was sustained five years after THR.