Intra-articular injections of steroid into the hip are used for a variety of reasons in current orthopaedic practice. Recently their safety prior to ipsilateral total hip replacement has been called into question owing to concerns about deep joint infection. We undertook a retrospective analysis of all patients who had undergone local anaesthetic and steroid injections followed by ipsilateral total hip replacement over a five-year period. Members of the surgical team, using a lateral approach to the hip, performed all the injections in the operating theatre using a strict aseptic technique. The mean time between injection and total hip replacement was 18 months (4 to 50). The mean follow-up after hip replacement was 25.8 months (9 to 78), during which time no case of deep joint sepsis was found. In our series, ipsilateral local anaesthetic and steroid injections have not conferred an increased risk of infection in total hip replacement. We believe that the practice of intra-articular local anaesthetic and steroid injections to the hip followed by total hip replacement is safer than previously reported.
The treatment of subtrochanteric femoral fractures remains difficult despite the introduction of modern intramedullary nailing techniques. Accurate fracture reduction, correct siting of the proximal entry point and restoration of medial support remain essential for a successful outcome. We report a case of failure of the spiral blade module of the AO unreamed femoral nail, which may have been precipitated by incorrect siting of the entry point, resulting in poor implant positioning within the femoral head.
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