Introduction

Bisphosphonates are among the most commonly prescribed drugs in Osteoporotic Patients. Their mode of action is anti-resorptive. Since remodeling is a key step in fracture healing, there has been concern regarding the effect of bisphosphonates on fracture healing.

Aims: Minimal invasive surgery is now possible for hip replacement. We present our system (called the SE Hip SystemTM). It is a universal system and is here used with the LINKTM C.F.P stem and T.O.P cup.

Methods: We have used this system on forty patients. It involves five steps. One (incision) – a single 5cm. postero-lateral incision; two (neck cut) – application of a cutting block to the femoral neck and removal of the head; three (broaching the femur) – preparation of the femur; four (reaming the acetabulum) – ream using the modified reamers and precisely place the cup with the lollipop device; five- place the stem and soft tissue balance with the spacers. The hip is then reduced and the wound closed.

Results: The average pre-operative Harris hip score was 28.64; the average post-operative score was 82.65. Complications included one transient sciatic nerve palsy. Average blood loss was 250 mls, the average time in hospital was 3 days and the average number of physiotherapy sessions required was 4.

Conclusions: Minimal invasive hip surgery is now possible. There is a markedly reduced cone of dissection. Navigation systems and intra-operative imaging are not required. This technique should minimize maltracking (and wear) and shorten the recovery period allowing the possibility of day or outpatient hip surgery.

Introduction: Over 75% of hospital-acquired infections are methicillin-resistant staphyloccoal (MRSA) infections. There is an urgent need to find alternatives to treat such infections. We report our experience with the use of a topical antibacterial agent, Polytoxinol, PT (TM), combined with debridement, for the treatment of wound and bone infections where antibiotics had failed. PT is a complex formulation of eucalyptic plant extracts, shown to be strongly bactericidal in vitro against a broad range of aerobic bacteria.

Methods: Staphylococcal infections were diagnosed in 6 cases by culture; 4 of these were confirmed as involving MRSA. In 8/9 patients, infection was localised at the site of ligament and/or bone surgery for repair of traumatic injury, or for prosthetic joint replacement.

Results: Prior to this series, PT was applied as a biological wound sealant to 180 orthoapedic patients with two instances of localised sensitivity.

Eight of the current 9 cases of wound infection, included 4 verified cases involving methicillin-resistant Staphylococcus aureus, were successfully treated by topical application of Polytoxinol, either without (6 patients), or in combination with systemic antibiotics (3 patients). In 8 patients, Polytoxinol application was followed by reduced inflammation, rapid granulation and healing even where infection was of > 2 years standing. Adverse local tissue reaction shown by 1 patient quickly subsided on withdrawal of Polytoxinol.

Conclusions: Polytoxinol antimicrobial liquid applied topically to infected wounds and bone is an effective broad spectrum bactericide. It has the potential to supplement, or in many instances replace, antibiotics in the treatment of such infections.