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Introduction: There has been an increased interest in minimally invasive direct anterior approach total hip arthroplasty (THA) to provide greater patient satisfaction, improve pain relief, and reduce the duration of hospitalisation. A direct anterior approach hybrid cemented THA, utilising a bikini line incision, can be technically challenging. We aimed to undertake radiological analysis of femoral stem cementation, clinical outcomes, and component survivorship. Methods: Over a 5-year period, 215 primary elective bikini anterior THA conducted by a single surgeon were included. All procedures were performed using a cemented collarless polished stem. The operation was performed on a standard operating table. Patients undergoing posterior approach, revision procedures, and fractured neck of femurs were excluded. Post-operative radiographs were analysed for femoral cementation quality using the Barrack grading system. Harris hip scores (HHS) were determined at 6 weeks, 12 weeks, annually thereafter and the difference in HHS was noted. Results: In total, 215 anterior bikini THA (R = 101, L = 114) were performed in 199 patients (M = 89, F = 110) with a mean age of 77 and mean follow up of 2.9 years (range = 0.5–5). Radiographic analysis of femoral cementation showed 189 femoral stems (88%) were either Barrack A or B cementation grade, suggesting optimal cementation. Lucency in the cement-bone interface occurred mainly in Gruen Zone 1 (43%) and Zone 13(46.9%). At the most recent follow-up (mean 2.9 years), component survivorship was at 99.54% (stem). Significant improvement was noted in Harris hip scores at final follow-up (from 54 preoperatively to 92.7 at 2.9 years postoperatively). Conclusion: Our results suggest that a bikini incision direct anterior approach for total hip arthroplasty can be safely employed to perform cemented femoral stems on a standard operating table.

We report a case of neglected anterior dislocation of the hip. A young man presented 5 months following a fall from a tree where he sustained the injury. An MRI of the hip confirmed avascular necrosis of the dislocated head of femur. A modified girdlestone operation was performed leaving the patient with a painfree functional hip. [ABSTRACT FROM AUTHOR]

Group B streptococci (GBS) birth canal colonisation in pregnant women and women of child-bearing age is well known. The recognition and incidence of infections caused by these organisms in non-pregnant and elderly adults are increasing. Clinical manifestations of GBS infections can range from simple skin and soft tissue infections to fatal meningitis in newborns. GBS as a cause of septic arthritis of the hip associated with pregnancy is previously unreported. We report a case of septic arthritis of the hip joint caused by GBS in a 30-year-old woman with a history of recent childbirth. Delay in recognition and lack of timely appropriate treatment of this condition henceforth led to severe destruction of the joint, requiring ultimate reconstruction of the joint with cemented total hip arthroplasty. This case report highlights the atypical presentation and rapidly destructive nature of this infection with catastrophic consequences. [ABSTRACT FROM AUTHOR]

Introduction: Mallet thumb injuries are uncommon. Traumatic avulsion injury of the extensor pollicis longus leads to significant difficulty., Case Report: A 55-year-old male patient presented with a closed hyper flexion injury to the thumb, resulting in pain and loss of active extension. Clinical examination and x-rays confirmed a soft-tissue mallet injury. The patient was treated non-operatively by immobilizing the interphalangeal joint of the thumb. The patient regained full range of motion., Conclusion: Non-operative treatment for acute closed mallet injury of the thumb provides satisfactory outcomes. It is suitable when a patient presents acutely., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Necrotising fasciitis of the extremities is a rapidly progressive, potentially life threatening soft tissue infection. Early diagnosis, aggressive surgical and critical care management is vital in preventing mortality. This series reports the clinical presentation, behaviour of inflammatory markers, histological, microbiological and radiological findings in seven cases, which presented to our orthopaedic unit over the last one year. Seven patients (4 male and 3 female) were included. Usual presentation was spreading erythema and pain. Duration of symptoms varied from 3 to 14 days. All except one case affected the lower limbs. The average Laboratory risk indicator for necrotising fasciitis (LRINEC) score on the day of presentation was 5. Imaging demonstrated subcutaneous oedema, fluid and air pockets in muscular planes. Group A beta haemolytic Streptococcus was the most common organism isolated from culture. Treatment modalities included antibiotics, immunoglobulins and surgical debridement. Four of the patients showed full remission. However, three (one with pre-existing carcinoma) of them succumbed to the condition.