Introduction:We aimed to investigate the rate of urinary retention after knee arthroplasty, the various factors involved in predicting those at risk for retention and to assess the impact of retention and catheterization on joint sepsis. Materials and Methods: A retrospective review was conducted of all available case notes of patients undergoing total knee arthroplasty in a consecutive 2-year period (2000)(2001)(2002). Adequate data was available for 142 patients. Results: 142 patients underwent total knee arthroplasty. 19 patients were catheterized preoperatively for monitoring urine output. 123 patients were not catheterized. Urinary retention occurred in 19.7% (28/142). The mean day of catheterization for retention was 0.66. The mean duration of catheterization in patients developing retention was 3.58 days and was 3 days in the patients catheterized pre -or perioperatively. Deep joint sepsis occurred in 2.1% (3/142) -only one had been catheterized and that was preoperatively. No case of infection had urinary retention or had a symptomatic urinary tract infection. The only factors predicting those at significant risk of retention following knee arthroplasty was a past medical history of urinary retention (p = 0.049) and postoperative morphine requirement (p = 0.035). No patients required urological surgical intervention at mean follow up of 1.97 years. Conclusions: This study supports the use of indwelling urinary catheterization for patients developing urinary retention after total knee arthroplasty.

It is well known that bronchogenic carcinoma frequently metastasises to the bony skeleton, but it is most unusual for it to present in the form of a musculoskeletal abscess. Presented here is the case report of a patient with what appeared initially to be a right sided gluteal abscess and which turned out to be the metastasis from a bronchogenic carcinoma. The Magnetic Resonance Image (MRI) scan carried out proved to be very helpful in arriving at a probable clinical diagnosis; however, it was histopathological studies of the abscess wall itself that ultimately gave the definitive diagnosis. We believe that this may represent one of the first documented cases in which on MRI scan has been used to confirm the presence of a gluteal abscess.

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A 26-year-old patient sustained a crush injury to the right arm following a drug overdose. The crush syndrome that developed was severe compared to the majority of cases previously reported. There was recurrent sepsis, coagulopathy, multiple organ failure and a near-fatal outcome.Case report