Intraoperative femoral condyle fracture is a significant but rarely reported complication during primary total knee arthroplasty (TKA). This is the first study to identify the incidence, risk factors, location and outcome of these fractures in an Asian population with modern posterior-stabilized (PS) TKA. Materials and methods: We reviewed 2682 consecutive primary TKAs performed between 2011 and 2017 in a single centre; 23 femoral condyle fractures were identified and analysed. Results: Fractures were managed conservatively with screw fixation or revision arthroplasty. Mean follow up was 3.0 years (range 3 months to 5.9 years). All patients achieved bone union and good functional outcome. The mean Knee Society Knee score was 89.4 (range 71-100) and the function score was 80.2 (range 60-95) at a mean of 3.0 years post-operation. Bilateral surgery was found to be a significant risk factor for femoral condyle fracture, while there was a higher trend of fracture in female patients and Stryker articular surface mounted (ASM) navigation. Conclusions: Intraoperative fracture is not uncommon with modern PS TKA. Postulated risk factors for fracture were discussed. Early identification of risk factors and a rigorous surgical technique may reduce risk of fracture. A good functional result was expected after proper treatment.

Purpose. To compare outcomes of 2 cohorts of patients who underwent total knee arthroplasty (TKA) before and after the introduction of a blood management protocol. Methods. Records of 97 and 96 consecutive patients who underwent unilateral TKA before and after introduction of the blood management protocol, respectively, were reviewed. Before introduction of the protocol, patients were cross-matched for blood before surgery. Transfusion after surgery was at the discretion of the surgeons or the on-call doctors. After introduction of the protocol, only patients with a preoperative haemoglobin level of <110 g/l underwent 'type and screening' of blood group. 2 units of blood were cross-matched preoperatively when multiple red-cell antibodies were identified or postoperatively when blood transfusion was required. Only patients with a postoperative haemoglobin level of <80 g/l or being symptomatic received blood transfusion until the haemoglobin level reached >100

a b s t r a c tMycobacterium fortuitum is a rapidly growing bacterium that can cause infection at different sites in humans. Prosthetic infection caused by this bacterium has historically been a challenge, with reimplantation being unsuccessful in all but one case. M. fortuitum is resistant to almost all conventional antituberculous medications. There is no standardised treatment due to its rarity of occurrence. Here, we report a case of successful reimplantation with initial debridement surgery and 6 weeks of antibiotics. IntroductionMycobacterium fortuitum is a recognised cause of soft tissue infections at different sites in humans, for example, the cervical region, 1 abdominal wall, 2 skin 3 and breast. 4 In the literature, only a few cases of M. fortuitum prosthetic infections have been reported. The outcome was poor with inevitable failure of reimplantation except in one case. 5 There is no consensus of treatment. Case reportA 64-year-old woman had osteoarthritis of both knees. Preoperative X-rays of her left knee (Figure 1) showed no obvious sign of infection. There had been a history of intra-articular injection of unknown drugs of both knees before left total knee arthroplasty ( Figure 2) (Legacy posterior stabilized knee, Warsaw, Zimmer) was performed in 2003. Preoperative and intraoperative assessments showed no signs of infection. At 10 weeks after the operation, the patient complained of increased pain in her left knee. Physical examination showed increased temperature in the left knee with effusion. The blood test showed an elevated C-reactive protein level of 48.9 mg/L. Left knee aspiration was done and joint fluid was sent for investigation. Joint fluid culture was negative but microscopy found an increased number of neutrophils. Acid-fast bacillus smear was negative. Acid-fast bacillus culture yielded M. fortuitum, which was sensitive to amikacin, ciprofloxacin and imipenem but resistant to rifampicin, tetracycline and clarithromycin.Exploration was done 12 weeks after the first operation. Intraoperatively, pus was found inside the joint. Removal of the implant and insertion of a hand-moulded articulating cement spacer made from one pack of antibiotic-loaded cement (500 mg tobramycin in 40 g Simplex cement) were performed (Figure 3). Intraoperative frozen section showed >20 neutrophils per high-power field (40Â). Intraoperative fluid culture showed mycobacterial species. After the operation, the patient was placed on intravenous amikacin (500 mg/day) for 6 weeks and oral ciprofloxacin (500 mg twice daily orally) for 6 weeks in total, as suggested by the microbiologist. Two months after insertion of the cement spacer, the pain improved and signs of inflammation subsided. The extension to flexion range of her left knee was 10e80 . The C-reactive protein level went down from 48.9 mg/L to 5.0 mg/L. One month later, revision total knee replacement (Figure 4) was done. Intraoperative frozen section confirmed that the neutrophils count was <5 per

Introduction: The use of bipolar prosthesis in the management of displaced fracture neck of femur has remained controversial. There has been a lack of long-term studies in its results and survivorship, especially in acetabular erosion. Methods: We retrospectively reviewed 108 single design bipolar hemiarthroplasties (105 patients) performed in a single centre between 1999 and 2008, with a mean follow-up of 7.4 years (range: 2.2–18.3 years). General indications of surgery include displaced fracture with age less than 75, narrow femoral canals not permitting the use of a monoblock implant or as salvage procedure for failed internal fixation. Results: Six hips (5%) required further surgery – two patients had debridement for infection and four patients required revision to total hip arthroplasty (THA) due to infection or aseptic loosening. There was no dislocation. No revision was required for acetabulum erosion. Kaplan–Meier analysis showed a 15-year survival free of revision due to any reason to be 93.1% and due to aseptic loosening to be 97.1%. Discussion: Our centre has shown excellent clinical results and low revision rate with the cemented bipolar system. In the context of displaced fracture neck of femur, the long-term results can be compared with THA which is associated with higher perioperative morbidity.

Journal of Orthopaedics, Trauma and RehabilitationJ o u r n a l h o m e p a g e s : w w w . e -j o t r . c o m & w w w . e j o t r . o rg http://dx.