• Despite advances in understanding and management, paediatric osteoarticular infections continue to pose diagnostic difficulties for clinicians. Delays in diagnosis can lead to potentially devastating morbidity.

• No single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively paediatric bone and joint infection. Diagnosis should be based on a combination of clinical signs, imaging and laboratory investigations. Algorithms should supplement, and not replace, clinical decision making in all cases.

• The roles of aspiration, arthrotomy and arthroscopy in the treatment of septic arthritis are not clearly defined. There is a very limited role for surgery in the management of acute haematogenous osteomyelitis.

• The ideal duration and mode of administration of antibiotic therapy for osteoarticular paediatric infection is not yet fully defined but there is increasing evidence that shorter courses (three weeks) and early conversion (day four) to oral administration is safe and effective in appropriate cases. Clear and concise antibiotic guidelines should be available based on local population characteristics, pathogens and their sensitivities.

• Kingella kingae is increasingly identified through polymerase chain reaction and is now recognised as the commonest pathogen in children aged under four years. Methicillin-resistant Staphylococcus aureus and Panton-Valentine leukocidin-producing strains of Staph. aureus are being increasingly reported.

• A multidisciplinary integrated evidence-based approach is required to optimise outcomes.

• Further large-scale, multicentre studies are needed to delineate the optimal management of paediatric osteoarticular infection.

Cite this article: EFORT Open Rev 2017;1:7-12. DOI: 10.1302/2058-5241.2.160027.

• Total knee arthroplasty (TKA) in patients affected by poliomyelitis is technically challenging owing to abnormal anatomical features including articular and metaphyseal angular deformities, external rotation of the tibia, excessive valgus alignment, bone loss, narrowness of the femoral and tibial canals, impaired quadriceps strength, flexion contractures, genu recurvatum and ligamentous laxity. Little information is available regarding the results and complications of TKA in this challenging group of patients.

• We carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of TKA in patients with poliomyelitis-affected knees. Six studies including 82 knees met the inclusion criteria and were reviewed. The mean patient age was 63 years (45 to 85) and follow-up was 5.5 years (0.5 to 13).

• All studies reported significant improvement in knee function following TKA. There were six failures requiring revision surgery in 82 cases (7%) occurring at a mean of 6.2 years (0.4 to 12). The reasons for revision surgery were aseptic loosening (17%, n=1), infection (33%, n=2), periprosthetic fracture (17%, n=1) and instability (33%, n=2). Thirty-six knees had a degree of recurvatum pre-operatively (44%), which was in the range of 5° to 30°. Ten of these knees (28%) developed recurrent recurvatum post-operatively.

• The findings support the use of TKA in patients with poliomyelitis-affected knees. The post-operative functional outcome is similar to other patients; however, the revision rate is higher. Quadriceps muscle power appears to be an important prognostic factor for functional outcome and the use of constrained implant designs is recommended in the presence of less than antigravity quadriceps strength.

Cite this article: EFORT Open Rev 2018;3:358-362. DOI: 10.1302/2058-5241.3.170028

• Background: Slipped capital femoral epiphysis (SCFE) results in alterations to femoral head anatomy, predisposing patients to degenerative hip disease at a young age. Total hip arthroplasty (THA) is performed to relieve symptoms and improve function. However, it can be associated with a variable outcomes and little evidence exists on the functional outcomes, complications and revision rate following such procedures.

• Purpose: The aim of this systematic review is to determine the safety and effectiveness of performing hip arthroplasty in patients with degenerative hips secondary to SCFE.

• Methodology: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature review was conducted of MEDLINE and Embase. Both single-arm and comparative studies were included. The outcomes of interest were functional scores, post-operative complications and revision rate.

• Results: Six studies fit the inclusion criteria. Of these, five were retrospective single-arm studies and one was a retrospective comparative study based on registry data.

• All studies reported significant improvement in hip function and quality of life after THA. An overall revision rate of 11.9% was reported, occurring at a mean of 6.5 years (0.75–18.7 years).

• THA in patients after SCFE leads to improved functional outcomes that are comparable to patients receiving THA for osteoarthritis. The revision rate appears to be higher than is reported in patients undergoing THA for osteoarthritis at mid-term follow-up. Further prospective comparative studies are needed to evaluate the efficacy of the treatment in more detail.

Cite this article: EFORT Open Rev 2021;6:539-544. DOI: 10.1302/2058-5241.6.200038