13 patients with tears in the gluteus medius tendon following total hip arthroplasty were studied. The diagnosis of a gluteal tear was made on the basis of clinical signs and a positive arthrogram of the hip in all cases. 11 patients underwent gluteus medius repair and two patients declined surgery. 10 patients attended a review clinic (eight gluteal repair patients and two conservatively managed patients) and three were reviewed by telephone and medical notes. The mean follow up was 61 months (range 12-116 months). The mean age at follow up was 71.42 years (69-79 years) and the male to female ratio was 5:8. The mean duration of symptoms prior to repair was 16 months. An anterolateral transgluteal approach had been used for primary surgery in nine cases and in four cases the original surgical approach was unknown. The mean Harris Hip score prior to repair was 77.4 (range 55-87), which improved to a mean post operative Harris hip score of 86.97 (range 79-96) following repair. The Oxford hip score prior to repair was 20 (range 16-25) which improved to a mean of 14.2 after repair (range 4-29). 9 out of 11 patients who had the repair were satisfied and would recommend the procedure. We believe an accurate and timely diagnosis together with repair can reduce the morbidity associated with this post-operative complication following THA.

We present a retrospective evaluation assessing the use of a novel fibrin sealant, Quixil® (OMRIX Biopharmaceuticals S.A.) in reducing blood transfusions following revision total hip replacement surgery. Forty four patients underwent revision total hip replacement surgery using Quixil®, while 45 patients underwent revision total hip replacement surgery without the use of Quixil®. The duration of surgery and patient demographics were similar in both groups. Average blood loss was 1,010ml in the Quixil® group versus 1,021ml in the non-Quixil group. The use of cell saver and intra-operative blood transfusion were similar in both groups. The mean pre-operative Haemoglobin was 13.0 g/dl in the Quixil® group versus 12.4 g/dl in the non-Quixil group. The mean post-operative haemoglobin was 10.2 g/dl and 9.1 g/dl in the Quixil® and non-Quixil groups respectively. There was no difference in the blood transfused post-operatively between the two groups. Total units of blood transfused in Quixil® versus non-Quixil group were 60 verus 86. Total units of intra-operative blood transfused in Quixil® versus non-Quixil group were 16 versus 23. The use of fibrin tissue adhesive in revision total hip arthroplasty seems to be an effective and reliable means to reduce blood-transfusion requirements and prevent post-operative decreases in hemoglobin.

This report is of a healthy 49-year-old male with an isolated primary single-joint septic arthritis of the right knee. The patient had no clinical symptoms or signs of systemic meningitis or detectable meningococci in the blood. The presentation is rare and can be unusual. Complete recovery does usually occur if appropriate antibiotics therapy, joint aspiration and repeat washouts are performed early.