Aims

Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking.

Periprosthetic joint infection (PJI) remains a challenging complication following Total Hip Arthroplasty (THA). It is associated with high levels of morbidity, mortality and is time consuming and expensive to treat. Our management generally relies on identification of the infecting organism(s) in order to define the appropriate treatment strategy. Patients with culture-negative PJI poses a greater challenge to surgeons and to the wider multidisciplinary team.

This study compares the outcomes of 50 consecutive complex culture-positive (deemed unsuitable for single stage exchange) and 50 culture-negative THAs managed with two-stage revision arthroplasty with a minimum of five years follow-up.

Culture-negative PJIs were associated with older age, smoking, external referral source and greater use of preoperative antibiotics. There was however no significant difference in outcome between these groups of patients with a similar complication rates and reinfection rates of 6% at 5 years.

Culture negative periprosthetic sepsis generates concern, and is often considered a poor prognostic indicator. This study suggests that a strict 2 stage protocol is associated with satisfactory outcomes in such cases.

The maintenance of quality and integrity in clinical and basic science research depends upon peer review. This process has stood the test of time and has evolved to meet increasing work loads, and ways of detecting fraud in the scientific community. However, in the 21st century, the emphasis on evidence-based medicine and good science has placed pressure on the ways in which the peer review system is used by most journals.

This paper reviews the peer review system and the problems it faces in the digital age, and proposes possible solutions.

Cite this article: Bone Joint J 2014;96-B:436–41.

The outcome after total hip replacement has improved with the development of surgical techniques, better pain management and the introduction of enhanced recovery pathways. These pathways require a multidisciplinary team to manage pre-operative education, multimodal pain control and accelerated rehabilitation. The current economic climate and restricted budgets favour brief hospitalisation while minimising costs. This has put considerable pressure on hospitals to combine excellent results, early functional recovery and shorter admissions.

In this review we present an evidence-based summary of some common interventions and methods, including pre-operative patient education, pre-emptive analgesia, local infiltration analgesia, pre-operative nutrition, the use of pulsed electromagnetic fields, peri-operative rehabilitation, wound dressings, different surgical techniques, minimally invasive surgery and fast-track joint replacement units.

Cite this article: Bone Joint J 2013;95-B:1587–94.