Introduction: Hot swollen knee joints are a common presentation in clinical practice. It has wide differential diagnoses, the most serious being septic arthritis. Delayed or inadequate treatment leads to joint damage. Arthroscopic lavage should be planned appropriately after proper clinical assessment and investigation. Other differential diagnoses like crystal arthritis, reactive arthritis, monoarticular inflammatory arthritis should be considered.

Patients and Methods: This retrospective audit involved 44 patients who had arthroscopic knee lavage for suspected septic arthritis from January 2005 to May 2007. Analysis included the aspects of adequate backup supportive evidence for the procedure, the time from diagnosis to operation and postoperative antibiotic regime.

Results: There were 29 males and 15 females with age group ranging from 11 to 91 yrs. Fever was present in 15 patients(34%), preoperative joint aspiration done in 22(50%), peri-operatively pus found in 11(25%). 13 patients(29.5%) had procedure done within 6hrs, causal organism identified in 25%. Follow-up ranged upto 12 months without persistence or reactivation.

Discussion: Arthroscopic lavage is a useful adjunct in treatment of septic arthritis of knees but proper patient selection with systematic approach considering other possible differential diagnoses is important for avoiding unnecessary operations.

In 1990 an estimated 1.3 million hip fractures occurred worldwide. Clostridium difficile diarrhoea has emerged as a healthcare associated infection of great clinical and economic significance especially in the frail and vulnerable group of fracture neck of femur patients. The major risk factor is peri-operative antibiotic exposure especially cephalosporins. A retrospective audit was performed to study the effect of C. Difficile in operated fracture neck of femur patients.

All the patients who were diagnosed with C. Difficile infection after an operated fracture neck of femur at the District general hospital from April 2004 till March 2007 were included in the present study. All patients received the routine peri-operative antibiotic prophylaxis of three doses of intravenous cefuroxime. Data collected included age, sex, duration between operation and the onset of diarrhoea, length of stay and associated mortality.

A total of 1023 patients underwent surgery for fracture neck of femur during the three years of study period. The average age of the patients was 81 years. 80% of the patients were females. A total of 62 patients suffered from C. Difficile diarrhoea (6%) after the arthroplasty procedure, and within this cohort, 29 patients died during the same admission to the hospital (47%). The average length of stay for a patient with fracture neck of femur was increased from 23.4 to 60 days in those affected with C. Difficile.

The patients with fracture neck of femur are generally elderly with poor body reserves. C.difficile infection in such patients not only adds to the morbidity, but also causes significant increase in the mortality rate. Propagation of simple infection control measures such as hand-washing and isolation and change of peri-operative antibiotic protocol led to a statistically significant reduction in the incidence of C.Difficile infections after fracture neck of femur surgery.

Introduction: A retrospective audit to evaluate the results of Austin Moore hemiarthroplasty conversion to Total hip arthroplasty for suspected aseptic loosening.

Materials and Methods: A consecutive cohort of patients who had conversion of Austin-Moore hemiarthroplasty to Total hip arthroplasty performed at our district general hospital between August 2000 and May 2006 were included in the study.

The total of 41 patients were divided into two groups depending on the duration between the primary hemiarthroplasty procedure and its revision to total hip arthroplasty – (1) Less than one year (16 patients) and (2) More than one year (25 patients).

The data collected included: age, sex, classification of the fracture, date of primary operation, surgical approach, inflammatory markers, indication and date of revision to total hip arthroplasty, and the final outcome.

Results: The rate of infection after the revision to total hip arthroplasty was found to be 25% (4/16 patients) in patients who underwent the revision operation within 1 year after the primary operation, whereas the infection rate was 8% (2/25 patients) for those who had the revision operation more than a year after the primary operation. The difference in infection rates between the two groups was found to be statistically significant despite the small numbers.

Discussion: The patients who have early loosening of the Austin-Moore hemiarthroplasty within the 1 year of the primary procedure should raise a suspicion of occult infection. Despite near normal inflammatory markers, a two-staged conversion to total hip arthroplasty should be seriously considered.

Introduction: Ankle fractures in the elderly is on the increase both in prevalence and severity. The major goal of treating displaced fractures in the elderly is rapid resumption of mobility. Review of literature showed better outcome was achieved by Open Reduction and Internal Fixation. Aim: to study the complication and reoperation rates following ankle fractures in the elderly population. Method: We studied the outcome following displaced ankle fractures in patients above the age of 55 admitted to Good hope hospital over the last þve years. The study was conducted on retrospective basis with a review of notes and x rays to assess the outcome. Result:The rate of complications and re-operation rate were studied. A total of 62 patients were identiþed with a mean age of 70. MUA and cast immobilisation was used in 13 patients, 3 patients treated with MUA and Percutenous K wire þxation and 41 patients were treated with Open reduction and internal þxation. One case in the MUA and cast immobilisastion group needed ORIF (7%). In the ORIF group, one case had to be re-operated to introduce a syndosmosis screw due to residual talar shift. The rate of complications in the ORIF group was 17%. Wound infection and delayed wound healing were the main complications. Based on the results of this audit, we believe that MUA and cast immobilisation supplemented with K wire þxation if necessary should be used as a þrst line of management in the elderly. Conclusion:The use of Open reduction and internal þxation should be reserved for þt and mobile patients with no circulation problems or osteopenia in order to avoid bone healing and wound complications.