When using a staged approach to eradicate chronic infection after total hip replacement, systemic delivery of antibiotics after the first stage is often employed for an extended period of typically six weeks together with the use of an in situ antibiotic-eluting polymethylmethacrylate interval spacer. We report our multi-surgeon experience of 43 consecutive patients (44 hips) who received systemic vancomycin for two weeks in combination with a vancomycin- and gentamicin-eluting spacer system in the course of a two-stage revision procedure for deep infection with a median follow-up of 49 months (25 to 83).

The antibiotic-eluting articulating spacers fractured in six hips (13.9%) and dislocated in five patients (11.6%). Successful elimination of the infecting organisms occurred in 38 (92.7%) of 41 hips with three patients developing superinfection with a new organism.

We conclude that prolonged systemic antibiotic therapy may not be essential in the two-stage treatment of a total hip replacement for Gram-positive infection, provided that a high concentration of antibiotics is delivered locally using an antibiotic-eluting system.

Obesity is increasing among patients requesting total hip replacement. Obesity is often considered though, a relative contraindication to arthroplasty surgery due to difficult access, greater blood loss, oozy wounds, poor mobilisation and delayed discharge. We have attempted to demonstrate the evidence for this.

Patients were evaluated preoperatively with regards to their height and weight to allow a body mass index (BMI) to be calculated. The length of inpatient stay was then monitored and early postoperative complications recorded. This data was used to assess if obesity or age could be used to predict a prolonged hospital stay caused by poor rehabilitation and early post operative complications.

The results of 70 consecutive patients between 1999–2001 are reported. The average age was 69.3 with a range of 46.5–85.4 years. The sex distribution was approximately 2:1 female to male (N=48:22 respectively). Two patients were identified as being under their recommended weight, 24 as healthy, 26 as over weight and 18 as obese. Urinary tract infection was confirmed by microbiological culture in 6 patients, superficial wound swab grew organisms in 5 patients while 2 developed culture positive chest infections. No thromboembolic events were recorded (Stroke, Deep Vein Thrombosis, Pulmonary Embolism) however one patient died of ischemic heart disease (BMI 35 obese). Data was examined by an Excel statistical package and an ANOVA plot produced.

No statistical relationship was found between obesity and infective postoperative problems. No delay in discharge was found when BMI was considered, R2 value of 0.0015,

F-significance 0.75. When age alone was considered R2 value of 0.003 and F-significance of 0.65 was recorded. When age and obesity were considered together R2 was 0.005 and

F-significance 0.57. We find no evidence of increased rates of early postoperative complications or delayed hospital discharge in obese patients with a BMI less than 40.