Between October 2001 and February 2002, 324 healthcare workers were screened for methicillin-resistant Staphylococcus aureus (MRSA) by nose and throat swabs. A positive finding led to activation of a standardised control programme for the affected person who was immediately excluded from work. Family members of those who were MRSA-positive were offered screening free of charge. An eradication programme was carried out in the permanent carriers. MRSA was found in 17 (5.3%) healthcare workers, 11 of whom proved to be permanent carriers, and six temporarily colonised. Three children of a positive healthcare worker showed nasopharyngeal MRSA, the acquisition of which occurred within the hospital. The standardised eradication programme for carriers was successful in most cases but failed in two individuals, whereupon systemic antibiotics were used successfully. The decolonised carriers, observed for more than one year, remained MRSA negative.

Isolation precautions in hospitals do not always prevent hospital staff and their families from acquiring MRSA. The identification of affected employees is difficult because in most cases only asymptomatic colonisation occurs. Screening and eradication can be complicated and costly, and for the affected employees the occupational consequences can be far-reaching as they have no guaranteed legal protection.

Introduction: Septic glenohumeral destruction is one of the most feared complications after operative fracture care. Unlike for other joints resection arthroplasty is not a possible alternative form of treatment. Our aim in this study was to assess the long-term results of shoulder arthrodesis in 15 patients after septic joint destruction.

Patients and Methods: Between 1978 and 1998 septic arthrodesis of the shoulder was performed in 15 patients. There were four women and 11 men with a mean age of 51.9 years. All patients were asked to return for clinical evaluation in June 2002. Three had died from unrelated causes and one from abroad had been lost for follow up. The outcome was evaluated according to the modified functional score of Hawkins and Neer and David, Makowski and Muhr. We recorded the complications, further operations, alterations in working habits, pain and patient satisfaction.

Results: The mean follow up was 8.3 years (3 to 14y). 3.8 (1 to 14) previous procedures had been performed. The entire 11 pat. were limited using their arm behind their backs. None was able to perform toilet hygiene and only one patient was able to reach his back pocket. Function at the level of the head in order to shave or to comb hair was difficult for the most, whereas nine patients were able to work at waist level. Eight were able to put on shoes and socks. Four were able to climb a ladder. All had had pain before surgery. On visual analogue scale, the mean preoperative level of pain was 7.9 and 3.3 after fusion. Complications occurred in 5 patients. 3 had persistent infection and failure of bony fusion requiring further surgery, one patient with persisting infection denied surgical interventions, one sinus tract healed after hardware removal.

Conclusion: The outcome depends on the individual patient and the indication for arthrodesis. To our knowledge, this is the first study which has investigated the long term results after arthrodesis indicated by septic joint destruction. Heavy tobacco misuse and a high number of previous procedures could be identified as risk factors for persisting of infection, persisting pain and failure of bony fusion with statistical significance.

The Alloclassic and Endoplus femoral stems have the same grit-blasted surface and are hot forged from the same titanium alloy. Only the external form of the implants differs slightly. It was our aim to examine the differences in radiographic bone response between the Alloclassic (second generation) and the Endoplus (third generation) femoral stems.

We compared 79 prostheses in 70 matched patients studied over a minimum of two years. Radiolucent lines, adaptive bone remodelling, subsidence, heterotopic bone formation and lysis were recorded in the Gruen zones.

Radiolucencies were mainly found in zones 1 and 7 but to a greater extent in the Endoplus than in the Alloclassic group (p < 0.001 in zone 1, p < 0.05 in zone 7). We found lucent lines in three or more Gruen zones in seven patients all of whom were in the Endoplus group (p < 0.05). Zones 2 and 6 had a significantly higher rate of lucencies in the Endoplus group (p < 0.001). We encountered a combination of proximal lucent lines in zones 1 and 7 with distal hypertrophy of the cortical bone in zones 2, 3, 5 and 6 in eight patients, all from the Endoplus group (p < 0.05). In other patients bone atrophy (stress shielding) in zones 2 and 6 was seen more frequently in the Endoplus than in the Alloclassic group (p < 0.001). In neither group was there radiological evidence of osteolysis. Heterotopic bone formation and subsidence occurred with similar frequency in both groups.

Our study shows that a small change in the form of the femoral implant can result in statistically significant radiological changes in bone remodelling. Whether this will result in clinical compromise is unknown. However, it seems likely that the Endoplus femoral stem will perform differently from the Alloclassic.

We analysed the long-term results of arthrodesis of the shoulder after infection in 15 patients. At the time of operation, 14 cultures were positive for Staphylococcus aureus. The mean follow-up was 8.3 years (3 to 14) and 90% of the patients were satisfied with the outcome. There were complications in five patients (33%); in three there was nonunion with loosening of the implant. One patient had a sound bony union but with a persistent sinus six years after arthrodesis and another had a sinus which healed after the metal was removed. Four of these five patients (80%) were heavy smokers (> 20 cigarettes/day). Cancellous bone grafting did not affect the incidence of complications. The mean age of the patients with complications was 58.6 v 48.6 years for those without (p = 0.2808 ; not significant). Those with complications had had more previous operations (6.4 v 2.5, p < 0.05). Antibiotics, as determined by the bacteriological cultures, were administered for six weeks.

The complication rate was higher in patients with active sepsis but the younger the patient and the fewer number of previous operations (< 50 years, < four previous operations), the better was the outcome. Considering the rate of complications, we recommend early surgery in these patients.