Arthrodesis of the knee following failed arthroplasty.

PURPOSE: Primary stability in arthrodesis of the knee can be achieved by external fixation, intramedullary nailing or plate fixation. Each method has different features and results. We present a practical algorithm for arthrodesis of the knee following a failed (infected) arthroplasty, based on our own results and a literature review. METHODS: Between 2004 and 2010, patients were included with an indication for arthrodesis after failed (revision) arthroplasty of the knee. Patients were analyzed with respect to indication, fusion method and bone contact. End-point was solid fusion. RESULTS: Twenty-six arthrodeses were performed. Eighteen patients were treated because of an infected arthroplasty. In total, ten external fixators, ten intramedullary nails and six plate fixations were applied; solid fusion was achieved in 3/10, 8/10 and 3/6, respectively. CONCLUSIONS: There is no definite answer as to which method is superior in performing an arthrodesis of the knee. Intramedullary nailing achieved the best fusion rates, but was used most in cases without--or cured--infection. Our data and the contemporary literature suggest that external fixation can be abandoned as standard fusion method, but can be of use following persisting infection. The Ilizarov circular external fixator, however, seems to render high fusion rates. Good patient selection and appropriate individual treatment are the key to a successful arthrodesis. Based upon these findings, a practical algorithm was developed.

The biodrying concept: an innovative technology creating energy from sewage sludge.

A full-scale biodrying installation was treating 150 kton (wet weight) of dewatered waste activated sludge per year. The waste was treated at thermophilic conditions (65-75 °C) in a 2-step forced aeration process reducing the total wet sludge weight by 73%. The final product had a high caloric value (7700-10,400 (kJ/kg)), allowing a combustion for energy generation in external facilities. The resulting product met the European microbial and heavy metal quality standards needed for an application as organic fertilizer. The facility used <0.5 MW of electricity and recovered 9.3 MW from biologically produced heat, which was internally used for the heating of office buildings. Produced ammonia, originating from the microbial conversion of organic matter, was recovered from the ventilated air in an acid gas scrubber as an ammonium sulphate solution 40% (w/w) (7.3 kton/year) and was sold as substitute for artificial fertilizers. The sustainability of this process is discussed relative to other sludge handling processes.

Microbiological cultures of allografts of the femoral head just before transplantation.

Allografts of bone from the femoral head are often used in orthopaedic procedures. Although the donated heads are thoroughly tested microscopically before release by the bone bank, some surgeons take additional cultures in the operating theatre before implantation. There is no consensus about the need to take these cultures. We retrospectively assessed the clinical significance of the implantation of positive-cultured bone allografts. The contamination rate at retrieval of the allografts was 6.4% in our bone bank. Intra-operative cultures were taken from 426 femoral head allografts before implantation; 48 (11.3%) had a positive culture. The most frequently encountered micro-organism was coagulase-negative staphylococcus. Deep infection occurred in two of the 48 patients (4.2%). In only one was it likely that the same micro-organism caused the contamination and the subsequent infection. In our study, the rate of infection in patients receiving positive-cultured allografts at implantation was not higher than the overall rate of infection in allograft surgery suggesting that the positive cultures at implantation probably represent contamination and that the taking of additional cultures is not useful.