The erythrocyte sedimentation rate and the C-reactive protein level provide excellent diagnostic test information for establishing the presence or absence of infection prior to surgical intervention in patients with pain at the site of a knee arthroplasty.

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Total hip arthroplasty in patients with previous above knee amputations is rare. We present a unique case where the patient had only 130 mm of proximal femur remaining following a previous traumatic above knee amputation. The short segment of femur meaning a conventional femoral stem could not be used. We describe the technique of total hip arthoplasty for this patient using a mini hip prosthesis and report a successful clinical and radiological outcome at 2 years post-op.

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The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307-1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment's nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £ 610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective.

Conventionally, culture medium is supplemented with fetal bovine serum (FBS): such serum presents potential risks of foreign protein contamination and transmission of viral or prion-related disease if used in culture of cells intended for human reimplantation. As it has been suggested that a composite of cultured human cancellous bone-derived cells and a bone graft substitute may present a solution to the well-recognized complications and limited availability associated with harvest of fresh bone graft, this study aimed to compare the proliferative response of human cancellous bone-derived cells supplemented with FBS or autologous human serum (AHS) to determine whether AHS is a practical alternative. Explant cultures were established using greater trochanter trabecular bone from 10 consenting patients (aged 57-84) undergoing total hip arthroplasty. At the same time, serum was harvested. The cells were characterized by alkaline phosphatase expression and by in vitro mineralization in enhanced medium. At confluence, cells were aliquoted into multiwell plates and grown for 9 days in medium supplemented with 5%, 10%, 15%, or 20% AHS or 10% FBS. Proliferative response was determined by a crystal violet dye binding assay. There was no significant difference between proliferation in 5% AHS and 10% FBS. However, 10%, 15%, and 20% AHS all produced significantly greater proliferation than 10% FBS. The proliferative response was dose related. FBS is said to be rich in growth and attachment factors, which is why it is widely used in tissue culture. These results suggest that species specificity, even when using adult serum, outweighs these advantages. It should therefore be considered as a prerequisite for any program involving reimplantation of cultured human cells. Clinical trials of cultured human cancellous bone-derived cells have now begun.