A retrospective review for enchondroma in the hand which had undergone operative treatment is presented. Twenty patients were treated operatively over a 10-year period. A total of 70% of the patients presented with pathological fracture. Enchondromas were most commonly located in the little finger (65%) and proximal phalange (60%). Enchondromas presented with pathological fractures and were treated definitively after the fracture had healed, except for one patient with open reduction, internal fixation of fracture, and bone grafting. All 20 patients underwent curettage of the enchondroma. In the same operative occasion, 16 patients received bone grafting, three patients received bone substitutes, and one had received bone cement. Fourteen (70%) of the patients suffered no major postoperative complications. Postoperative stiffness was encountered in seven patients. A secondary operation for relief of postoperative stiffness was performed in three patients. Factors were assessed for their risk of resulting in postoperative stiffness and occurrence of secondary operation. Factors included sex, age, pathological fracture, location of lesion, and preoperative stiffness. Only preoperative stiffness was a statistically significant risk factor contributing to postoperative stiffness and occurrence of a secondary operation.

Background: Total knee arthroplasty is a common procedure for treatment of various non-infective arthritis. This study reviewed total knee arthroplasty cases up to 10 years of follow-up for the survival rate, reasons of revision and associated perioperative risk factors for revision. Methods: All cases to total knee arthroplasty performed in a single centre in the years 2007 and 2008 were reviewed. A total of 227 cases of total knee arthroplasty were performed during the 2-year period, with 156 cases followed up to 10 years. Perioperative information, follow-up information and information of possible complications were obtained. Results: The survival rate of total knee arthroplasty in this study is 98.2% at 5 years and 94.2% at 10 years of follow-up. The early post-operative complication rate was low, and majority of cases had improvement of function at 1 year after the operation. Early post-operative infection rate was low at 0.4%, and overall infection up to 10 years of follow-up was also low at 4.4%. Ten cases had undergone revision of arthroplasty by 10 years after operation. Conclusion: The survival rate of total knee replacement was high. The revision rate and infection rates were low up to 10 years of follow-up. The most common reasons of revision arthroplasty were infection and aseptic loosening. Cases which required revision arthroplasty had significantly longer operative duration compared with cases without revision at 10 years of follow-up ( p = 0.01).

Hydrogen peroxide (H2O2) is a commonly used chemical agent in orthopaedic practice for antisepsis, haemostasis and preparation of bone bed for cementation. However, the associated risks of H2O2 usage are not widely known. We report a case of suspected air embolism after use of H2O2 during drainage of a septic arthritis of the shoulder. Upon our literature review, we were able to demonstrate H2O2 to be beneficial in antisepsis and care of chronic wounds. However, it has not been proven to be superior to other antiseptics commonly used in orthopaedic surgery. Regarding its use in cementation, there is evidence to show it is more effective than saline however, the use of pulsatile lavage appears to be the most important factor affecting the quality of cementation. H2O2 has not been shown to be helpful with haemostasis. Prior to the use of H2O2, one should be cautious and understand its associated risks and precautions.

A 76 year old female, with a background history of eczema and iatrogenic Cushing syndrome, received a right total knee replacement for her knee osteoarthritis. In the early post-operative period, a small amount of discharge was noted from the surgical wound. The wound swab culture of the discharge yielded candida species. It was regarded as contamination initially. Half year later, she presented with a subcutaneous abscess around the right knee. Aspiration and culture confirmed infection of Candida parapsilosis. The patient was treated conservatively with fluconazole because she had initially refused operative treatment. The infection progressed to abscess formation afterward. A two-stage revision arthroplasty with cement spacer was performed subsequently. In addition, we have reviewed the literature regarding fungal periprosthetic joint infection.