It is clear from this study that no single test is able to show the presence of infection in every case. Classical clinical signs, laboratory tests, special imaging studies and joint aspirations have all yielded a notable rate of false negative results. Therefore, we recommend that, if arthroplasty patients have pain in prosthetic joint without clear radiological evidence of loosening, bone scans and preoperative joint aspirations should be undertaken. Also, if radiological evidence of loosening is accompanied with one or more of following criteria; C-reactive protein level elevated, radiologic evidence of infection, loosening within the first five years after implantation. In case of infection a delayed two-stage reconstruction should be managed.

Between 2002 and 2008, 130 consecutive ankles were replaced with an hydroxyapatite (HA) and titanium-HA-coated Ankle Evolutive System total ankle prosthesis. Plain radiographs were analysed by two independent observers. Osteolytic lesions were classified by their size and location, with cavities > 10 mm in diameter considered to be 'marked'. CT scanning was undertaken in all patients with marked osteolysis seen on the plain radiographs. Osteolytic lesions were seen on the plain films in 48 (37%) and marked lesions in 27 (21%) ankles. The risk for osteolysis was found to be 3.1 (95% confidence interval 1.6 to 5.9) times higher with implants with Ti-HA porous coating. Care should be taken with ankle arthroplasty until more is known about the reasons for these severe osteolyses.

This retrospective study evaluated the outcome of total wrist fusion, predominantly using the Mannerfelt technique, in patients with rheumatoid arthritis. One hundred and fifteen patients were operated on for painful wrist destruction. The mean pain scores were 3.6 (1-4) pre-operatively, 1.9 (1-4) after 6 weeks and 1.3 (1-4) at 1 year. Although the radiological fusion rate was good, only 40% of the patients were very satisfied with the result. Ability to perform activities of daily living was only very much improved in 30% of the patients. Grip strength significantly improved after surgery.

Abstract:A 44-year old man with prolonged frozen hip was treated with manipulation under anesthesia and pressure dilatation of the left hip joint. The treatment was successful and after one year the hip was symptomless.

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