Background: Two-stage revision arthroplasty remains the gold standard for managing infected hip replacements. Subspecialisation, high-volume hospitals and surgeons have been linked to improved clinical outcomes. The aim of this study was to assess clinical outcomes of 2-stage revision infected hip replacements of a subspecialist surgeon. Methods: Consecutive single surgeon series of 2-stage revisions of infected total hip replacements in a district genearl hospital settings with minimum 2 years follow up using clinical and patient-reported outcome measures. Results: Twenty-nine consecutive patients were included with average follow up of 5 years (range 2-9 yrs). Average age was 63 yrs (range 30-75), osteoarthritis was the underlying diagnosis in 65%, 31% had previous hip surgeries prior to index hip replacements. Two-thirds presented with chronic infections, staph aureus was isolated in 55%. Infection eradication rate at final follow up was 96.5% (1 reinfection). Overall complication rate was 13.8% (1 dislocation, 1 reinfection, 2 post-op wound haematoma requiring wash-outs). Mean patients reported outcome measures at final follow up were WOMAC hip score 76.3 (SD 13.6) (range 39.1-94.5); Oxford hip score 35.4 (SD 7.7) (range 17-45); and Hip disability & osteoarthritis outcome score (HOOS) 76 (SD 12.5) (range 41.9-92.5) suggesting satisfactory patient-reported outcomes. Conclusions: Our study demonstrates successful clinical outcomes and high infection-eradication rate achieved within district general hospital settings. Our experience suggests that comparable outcomes to tertiary centres in managing periprosthetic joint infections can be achieved in district general hospital settings through a local pathway of subspecialty trained arthroplasty surgeons within a local multidisciplinary MDT approach and adequate microbiology support.

Case series, level IV.

Infected total hip replacements pose a diagnostic and management challenge. Careful history, clinical examination, blood tests, plain radiographs and hip aspiration are all part of the clinical assessment. International consensus on establishing the diagnosis helps surgeons to formulate management plans. Management strategies include debridement and prosthesis retention, single-stage revision, two-stage revision, suppressive antibiotic treatment and excision arthroplasty. This article reviews the clinical assessment, diagnosis, principles of surgical management and outcomes of revision surgery of infected total hip replacements.

Calcific myonecrosis is a rare benign condition affecting mainly the muscles of a single leg compartment. It is thought to follow a history of trauma with a latent period of years. Patients present with a slowly growing mass. Differential diagnosis from a malignant tumour can be made from the history and the distinctive radiographical features of a fusiform lesion with predominantly peripheral calcifications. Magnetic resonance imaging may be necessary to confirm the diagnosis; treatment is largely symptomatic.

No abstract