A 66-year-old man presented with an infected resurfacing hip replacement in the immediate post-operative period following an uneventful transurethral resection of the prostate. Prophylactic antibiotics had been administered on induction of anaesthesia. The hip prosthesis had been inserted seven years previously and had been hitherto asymptomatic. The hip was washed out and microbiological examination identified Despite current recommendations, clinicians undertaking invasive procedures which can lead to bacteraemia in patients with prosthetic joint replacements should be aware of the risk of haematogenous seeding in such prostheses, which although low, has potentially disastrous consequences.
Three cases are reported which presented as "irritable" or "observation" hips and failed to respond to rest at home and in hospital. In each case a campylobacter organism was grown from the faeces; none were found in a group of 20 patients in the paediatric ward for other reasons. The patients responded to a course of erythromycin. It is postulated that they may have had a reactive arthropathy of the hip and suggested that cultures for Campylobacter be made as part of the investigation of irritable hip.
1. The pathology of actinomycosis is briefly summarised, especially its method of invading bone by direct spread. 2. The manifestations, diagnosis and treatment of spinal involvement are considered. 3. The literature is brought up to date with
Thirty patients with non-tuberculous pyogenic osteomyelitis of the spine are reported in all of whom the diagnosis was confirmed bacteriologically, histologically or serologically. The clinical and radiological features and investigations are analysed. Back pain, localised to the level involved, was the predominant symptom. The erythrocyte sedimentation rate was raised in all cases, and a characteristic sequence of radiological features is described.
