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Peri-prosthetic infection is amongst the most common causes of failure following total knee replacement (TKR). In the presence of established infection, thorough joint debridement and removal of all components is necessary following which new components may be implanted. This can be performed in one or two stages; two-stage revision with placement of an interim antibiotic-loaded spacer is regarded by many to be the standard procedure for eradication of peri-prosthetic joint infection. We present our experience of a consecutive series of 50 single-stage revision TKRs for established deep infection performed between 1979 and 2010. There were 33 women and 17 men with a mean age at revision of 66.8 years (42 to 84) and a mean follow-up of 10.5 years (2 to 24). The mean time between the primary TKR and the revision procedure was 2.05 years (1 to 8).Only one patient required a further revision for recurrent infection, representing a success rate of 98%. Nine patients required further revision for aseptic loosening, according to microbiological testing of biopsies taken at the subsequent surgery. Three other patients developed a further septic episode but none required another revision.These results suggest that a single-stage revision can produce comparable results to a two-stage revision. Single-stage revision offers a reduction in costs as well as less morbidity and inconvenience for patients.Cite this article: Bone Joint J2014;96-B:759–64.

Ankle injuries are a common presentation of patients to the emergency department. When fractures are noted around the ankle, it is mandatory that the entire leg and knee are examined. We present three cases of patients who attended our emergency department with ankle injuries. Each patient was diagnosed with isolated malleolar fractures and discharged to the fracture clinic. On review by the orthopaedic team, they were all found to have associated proximal fibula fractures, the Maisonneuve injury, which required surgical intervention. Maisonneuve type injuries are easily overlooked in busy emergency departments. Full clinical examination of the entire limb is mandatory and suspicion should be raised if there is (a) tenderness on palpation of the proximal fibula; (b) evidence of talar shift within the joint; (c) isolated malleolar or fibula fractures.

Ankle injuries are a common presentation of patients to the emergency department. When fractures are noted around the ankle, it is mandatory that the entire leg and knee are examined. We present three cases of patients who attended our emergency department with ankle injuries. Each patient was diagnosed with isolated malleolar fractures and discharged to the fracture clinic. On review by the orthopaedic team, they were all found to have associated proximal fibula fractures, the Maisonneuve injury, which required surgical intervention. Maisonneuve type injuries are easily overlooked in busy emergency departments. Full clinical examination of the entire limb is mandatory and suspicion should be raised if there is (a) tenderness on palpation of the proximal fibula; (b) evidence of talar shift within the joint; (c) isolated malleolar or fibula fractures.

Strangulation of the penis and scrotum with a constricting device is very rare compared to the penis alone. We report a case of a 47-year-old gentleman who presented with a metal ring constricting the base of his penis and scrotum. The metal ring was successfully removed with a hydraulic-driven cutter. He recovered with no complication.

Biplanar radiography was used to assess bony union after intertransverse fusion. The patients were assessed clinically and the fusion status was compared with the clinical result.