The aim of this study was to assess the role of synovial C-reactive protein (CRP) in the diagnosis of chronic periprosthetic hip infection. We prospectively collected synovial fluid from 89 patients undergoing revision hip arthroplasty and measured synovial CRP, serum CRP, erythrocyte sedimentation rate (ESR), synovial white blood cell (WBC) count and synovial percentages of polymorphonuclear neutrophils (PMN). Patients were classified as septic or aseptic by means of clinical, microbiological, serum and synovial fluid findings. The high viscosity of the synovial fluid precluded the analyses in nine patients permitting the results in 80 patients to be studied. There was a significant difference in synovial CRP levels between the septic (n = 21) and the aseptic (n = 59) cohort. According to the receiver operating characteristic curve, a synovial CRP threshold of 2.5 mg/l had a sensitivity of 95.5% and specificity of 93.3%. The area under the curve was 0.96. Compared with serum CRP and ESR, synovial CRP showed a high diagnostic value. According to these preliminary results, synovial CRP may be a useful parameter in diagnosing chronic periprosthetic hip infection.

Cite this article: Bone Joint J 2015; 97-B:173–6.

Introduction: Tennis Elbow affects 2% of the general population. 90% respond well to conservative management. Different surgical options are available for the treatment of recalcitrant Tennis Elbow. One of the most simple is percutaneous lateral release.

Methods: Prospective analysis of 31 patients, who failed a trial of conservative treatment, and underwent a lateral release of the common extensor origin under local anaesthetic as a day case. The symptoms had been present for an average of 21 months. Patients were scored for pain, activity and satisfaction.

Results: Pain relief was achieved in 90.3%, patient satisfaction in 90.3% and a return to full activity in 93.5%. The results were good in 28, fair in 2 and poor in 1. Return to work was on average after 4 weeks.

Conclusion: It is a simple, safe and effective procedure. It should be offered at an earlier stage, in those who failed conservative treatment. If all other procedures are equally effective, it is logical to choose the simplest.

Introduction: Diagnosis of rotator cuff tears by clinical examination and MRI is not always accurate. If the extent of the tear could be predicted pre-operatively, both the patient and the surgeon would be better equipped for the subsequent operation and rehabilitation.

Aim: To assess the accuracy of clinical examination and MRI in detecting the presence of rotator cuff tears.

Method and Results: Retrospective analysis of 86 patients with symptoms and signs of rotator cuff disease. All underwent clinical examination of the shoulder followed by an MRI scan. The diagnosis was confirmed intra-operatively.

Sensitivity of clinical examination for all tears was 69%, with a specificity of 64% and a positive predictive value of 80%. Individual sensitivities were as follows: grade I 50%, II 76%, III 100%. MRI had a sensitivity of 82.8% for all tears, specificity of 57% and a positive predictive value of 80%. Individual sensitivities: I 69%, II 90%, III 100%.

Conclusion: In some patients clinical examination remains uncertain, MRI is helpful but the diagnosis is not always reliable.