Bone and joint infections of the lower limbs cause significant morbidity for patients. Infection is a devastating complication for prosthetic joint replacements. In this large case series from a single centre in the NE of England, we present our experience of using antibiotic impregnated dissolvable synthetic pure calcium sulphate beads [Stimulan R]1 for local elution of antibiotics at the site of infection.

At our centre, from August 2012 to Jan 2015, antibiotic impregnated dissolvable synthetic pure calcium sulphate beads [Stimulan R]1 was used for local elution of antibiotics in 45 patients with lower limb bone or joint infections. Tailored plans were made by Orthopedic surgeon and Microbiologist MDTs based on bacteria and sensitivities.

Cases included 20 THR, 13 TKR, 5 Hemiarthroplasties, 4 tibial nonunions, 1 infected femoral plate and 2 paediatric osteomyelitis.

Organisms isolated – Coagulase negative Staphs, Staph aureus, MRSA, E coli, Enterococcus, Enterobacter cloacae, Serratia and 1 Salmonella typhimurium!!

In our cases, a combination of Vancomycin and Gentamicin was added to Stimulan beads following manufacturer's mixing guide. In 2 cases, we added Ceftazidime to the beads and Daptomycin in 1 case.

In bone infections, surgical debridement and systemic antibiotics were also needed. All arthroplasty infections underwent explantation with addition of antibiotic impregnated beads either at single stage or both stages of 2 stage revisions and systemic antibiotics.

Follow up (ranging 9months to 2 years) indicates no failure so far. The beads caused no excessive wound drainage. There was no need to remove beads as they dissolve. In the cases where a staged revision was performed, the beads were inserted at first stage and there was microbiological clearance of infection at 2nd stage. Our series includes some experince in paediatric cases too.

As far as we are aware, this is the largest series in the UK from a single centre reporting experience with Stimulan in infected bone and joints of the lower limbs. Our experience suggests use of dissolvable pure Calcium sulphate beads impregnated with carefully selected antibiotics, works as an effective adjunct to current treatments and offers flexibility with choice of antiobiotics that can be added locally.

The JRI cemented total hip replacement consisted of an acetabulum with a gamma irradiated UHMW polyethylene cup encased in a titanium metal shell, a 32 mm titanium head, and forged titanium alloy stem. Revision of this implant for failure, in particular that of the acetabulum, and the lack of published survivorship prompted a retrospective review of the local series. Data was compiled from theatre log books, patient records and X-rays.

During the period 1989–1997 a single surgeon performed 304 total hip replacements using this JRI prosthesis through an anterior lateral approach. The average age was 70 (48–96), with 186 (61%) female and 85% performed for osteoarthritis. Complete data was available in 236 cases to allow further analysis. The average follow up was 9.3 (1–17) years. During this period 37 hips had to be revised: 28 for a loose acetabulum, both components were loose in 5, and 3 had revision for infection. The mean time to revision was 7.4 (1–17) years.

This data provides a revision rate of at least 16% at ten years. This data does not take potential earlier radiographic failure nor patient function into account. This prosthesis therefore fails to comply with modern benchmarks for survivorship of implants. Furthermore this study highlights the importance of ongoing review of patients who have undergone joint replacement, in particular those with implants that have problems with design, as has been demonstrated in other metal backed components.

Introduction: Following surgical discectomy for pro-lapsed lumbar intervertebral disc, a proportion of patients develop leg symptoms on the side contra-lateral to the original surgery. Among other causes, subsequent disc space narrowing together with on-going degenerative changes may cause root entrapment in the lateral recess or in the intervertebral canal at the level of the previous disc prolapse.

It has been previously reported that the results of discectomy are less successful in patients with pre-existing spinal stenosis. It may be argued that patients with a narrow spinal canal would be more prone to the development of contra-lateral symptoms. The aim of this study was to determine whether any measurement on the pre-operative CT scan could predict the development of contra-lateral symptoms, or provide an indication for prophylactic decompression of the contra-lateral side at the time of the original surgery.

Materials & Methods: In a retrospective cohort of 43 patients following lumbar discectomy, eight subsequently developed symptoms on the contra-lateral side of whom three required subsequent contra-lateral surgery. A relationship was demonstrated between a measurement taken on the pre-operative CT scan (the oblique sub-facet distance) and the occurrence of contra-lateral symptoms following discectomy.

Conclusion: An oblique sub-facet distance of 8mm or less predicted the development of contra-lateral symptoms with a sensitivity of 75 % and a specificity of 74%.

The results of fifty-one Manchester knee arthroplasties in forty-one patients are reviewed and discussed. Excellent and good results were obtained in 85.4 per cent of arthroplasties. Varus and valgus deformity can be corrected and stability preserved or restored. Complications occurred in only twelve patients but resolved in all except one.