Total hip joint replacement offers dramatic improvement in the quality of life but periprosthetic joint infection (PJI) is the most devastating complication of this procedure. The infection threatens the function of the joint, the preservation of the limb, and occasionally even the life of the patient due to long term hospitalization and high cost. For the surgeon it is a disastrous burden, which requires repeated, complicated procedures to eradicate infection and to provide a mobile joint without pain. Yet in the absence of a true gold standard, the diagnosis of PJI can be elusive. Synovial fluid aspiration, diagnostic imaging, traditional culture, peripheral serum inflammatory markers, and intraoperative frozen sections each have their limitations but continue to be the mainstay for diagnosis of PJI. Treatment options mainly include thorough irrigation and debridement with prosthesis retention, or a two-stage prosthesis exchange with intervening placement of an antibiotic-loaded spacer. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic PJI. Debridement, antibiotics and implant retention is the obvious choice for treatment of acute PJI, with good success rates in selected patients. This article presents an overview of recent management concepts for PJI of the hip emphasizing diagnosis and the clinical approach, and also share own experience at our institution.

Level IV.

Sciatic nerve compression due to a ganglion cyst around the posterior aspect of the hip joint is not commonly described in literature. We report a rare case of a 63-year-old man with a ganglion cyst around his hip joint, who presented with symptoms of sciatica. After excision of the cyst, the patient was symptom free. A high index of clinical doubt and detailed clinical examination is required for non-palpable cystic lesions in close proximity to the sciatic nerve in patients presenting with symptoms of sciatica and in patients with concomitant of lumbar disk herniation.

Vascular anomalies is associated with increased complexity and complication during live donor nephrectomy. We hereby report a right transperitoneal laparoscopic nephrectomy done in donor with complete left sided IVC (LIVC). Preoperative evaluation by CT Angiography clearly demonstrated venous anomaly. In view of long right renal vein, right laparoscopic donor nephrectomy was performed. Length was sufficient for anastomosis in recipient. Recipient's serum creatinine was 1.2 mg/dl on 5 th postoperative day. Postoperative stay for donor was uneventful. LIVC is not a contraindication for transperitoneal Laparoscopic donor nephrectomy.

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