Effective carbon and nutrient treatment solutions for mixed domestic-industrial wastewater in India.

The present study evaluates effectiveness of up-flow anaerobic sludge blanket (UASB) reactor followed by two post-anaerobic treatment options, namely free-surface, up-flow constructed wetland (FUP-CW) and oxygen-limited anaerobic nitrification/denitrification (OLAND) processes in treating sewage from the peri-urban areas in India receiving illegal industrial infiltrations. The UASB studies yielded robust results towards fluctuating strength of sewage and consistently removed 87-98% chemical oxygen demand (COD) at a hydraulic retention time of 1.5-2 d. The FUP-CW removed 68.5±13% COD, 68±3% NH4+-N, 38±5% PO4(3-)-P, 97.6±5% suspended particles and 97±13% fecal coliforms. Nutrient removal was found to be limiting in FUP-CW, especially in winter. Nitrogen removal in the OLAND process were 100 times higher than the FUP-CW process. Results show that UASB followed by FUP-CW can be an excellent, decentralized sewage treatment option, except during winter when nutrient removal is limited in FUP-CW. Hence, the study proposes bio-augmentation of FUP-CW with OLAND biomass for overall improvement in the performance of UASB followed by FUP-CW process.

A stemmed acetabular component in the management of severe acetabular deficiency.

We evaluated the use of a stemmed acetabular component in the treatment of severe acetabular deficiency during revision and complex primary total hip arthroplasty. There were 31 hips of which 24 were revisions (20 for aseptic loosening, four for infection) and the remainder were complex primary arthroplasties. At a mean follow-up of 10.7 years (6 to 12.8), no component had been revised for aseptic loosening; one patient had undergone a revision of the polyethylene liner for wear. There was one failure because of infection. At the latest follow-up, the cumulative survival rate for aseptic loosening, with revision being the end-point, was 100%; for radiographic loosening it was 92% and for infection and radiographic loosening it was 88%. These results justify the continued use of this stemmed component for the reconstruction of severe acetabular deficiency.

Partially hydroxyapatite-coated stemmed acetabular cup and nonstructural bone-graft in the management of severe acetabular deficiency.

We evaluated the use of a stemmed acetabular cup with morcellized allograft in the treatment of severe acetabular deficiency requiring reconstruction at arthroplasty. There were 29 hips, of which 22 were revision operations (18 aseptic, 4 postinfective) and 7 were complex primary hip replacements. All patients had severe acetabular deficiency as classified by the American Academy of Orthopaedic Surgeons: type IIB, 3; type IIIa, 18; type IIIB, 8. The patients had a mean follow-up of 46 months (range, 14-74 months). The hip center of rotation improved from a mean preoperative, side-to-side difference of 11.5 mm to 2.5 mm postoperatively (P < .001 ). The medial bone stock improved from a mean preoperative value of 1.5 mm to 11 mm postoperatively (P < .001). The Harris Hip Score improved from a mean preoperative score of 42 points to a postoperative score of 84 points (P < .001 ). There was 1 case of failure resulting from sepsis. The early results with this method of reconstruction of severe acetabular deficiency show encouraging restoration of bone stock, with no cases of aseptic loosening until the last follow-up.

Olecranon screw traction for displaced supracondylar fractures of the humerus in children.

Twenty six children with severely displaced supracondylar fractures were treated with closed reduction and vertical osseous traction with an olecranon screw. Four children required a second operation in the form of open reduction and K-wire fixation for failure to achieve a satisfactory reduction. After a mean follow up of 48 weeks, 20 children (91 per cent) had an excellent result with no significant loss of movement. Two children (9 per cent) had minimal cubitus varus (av. 8 degrees) which did not require a corrective osteotomy. All four children who had a second operation had an excellent result. The average hospitalisation time was 19 days. The method of olecranon screw traction is technically easy to perform and carries few risks of complications.

Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine.

STUDY DESIGN: To evaluate the role of single stage decompression with anterior interbody fusion with posterior instrumentation and deformity correction of tuberculous kyphosis of the dorso-lumbar spine in patients with/without neurological deficit. OBJECTIVES: (1) To evaluate the amount of kyphosis correction with single stage surgery and its progression with time. (2) To evaluate the neurological recovery. (3) To evaluate the bony anterior interbody fusion. SETTING: King Edward Memorial Hospital, Bombay, India. METHODS: Twenty-eight patients with post-tuberculous kyphosis deformity averaging 64.3 degrees (range 17 to 105) were treated by a single stage posterolateral decompression, correction of kyphosis, anterior interbody fusion and posterior instrumentation. RESULTS: The mean kyphosis correction obtained was 62.5% with the mean post-operative kyphosis angle reducing to 24.1 (range 5-60). At a mean follow-up of 5.8 years (4-7 years) the mean kyphosis angle loss was 3.2 degrees (range 0-5 degrees ). Of the 23 patients with neurological deficit, recovery was seen in 21 cases (91.3%) while deterioration was seen in one case (4.3%). The remaining five patients were neurologically intact pre-operatively. Bony fusion was seen in all cases at 9 months. One patient with subpulmonary function died post-operatively (mortality 3.5%). CONCLUSION: The results of our series are encouraging. However single stage decompression with fusion and kyphosis correction is a very demanding surgery and should be performed after taking into account the risks and benefits involved. This surgery perhaps prevents progression of neurological deficit and recurrence of late onset paraplegia in these complex cases in developing countries.

The uncemented Bicontact total hip arthroplasty in octogenarians. Medium-term results.

Uncemented total hip arthroplasty was developed on the principle of biological fixation to enhance longevity of the prosthesis. Though the role of uncemented total hip replacement as an alternative is well accepted in young patients, its role in elderly remains controversial. We reviewed a consecutive series of 60 uncemented Bicontact total hip arthroplasties in 51 octogenarian patients with a mean follow-up of 7 (range 5-9) years. Mean patient age was 87.8 (range 80-97) years. Mean preoperative Harris hip score of 48 (range 32-65) improved postoperatively to a mean of 88 (range 58-94). There were 26 hydroxyapatite (HA) and 34 non-HA plasma pore-coated acetabular cups; one cup was revised for recurrent dislocation. Radiological evaluation revealed no unstable cups; however, two were "probably unstable" (one non-HA and one infection in an HA-coated cup) and two "possibly unstable" (one HA and one non-HA cup) ( P <0.05). None of these cups were clinically symptomatic. Two femoral stems were considered "possibly unstable" and one stem "fibrous stable", while the remaining stems were "osseo-integrated". There were no revisions of either femoral stem or cup for aseptic loosening. Using the recommendation of revision as the end point, cumulative prosthesis survival rate was 98.4% at a mean follow-up of 7 years (95%CI: 95.9-99.4%). However, cumulative survival with revision being the end point for aseptic loosening was 100% for the Bicontact prosthesis. Results of our series are encouraging and justify the continued use of this prosthesis in the elderly.

Should the patella be replaced in total knee replacement?

In 170 total knee arthroplasties for osteoarthritis 71 did not receive a patellar replacement (group A), while 99 knees had a cemented polyethylene patella (group B). The mean follow-up time was 36 months (30-50 months). In group A 10 patients underwent second-stage patellar resurfacing and in group B 2 knees underwent revision of the patellar component. Radiologically the average patellar congruency was similar. In both groups there were 21 non-congruent knees. In group A 8 were symptomatic and had low scores compared to 2 in group B (P<0.05). The mean HSS score and patellar score were higher in group B than in group A (P<0.05).

Management of gap non-union of tibia by tibialisation of ipsilateral vascular fibula.

Gap non-union of tibia following traumatic bone loss or infection dramatically emphasizes the limitation of conventional reconstructive techniques. With presence of significant skin loss or poorly vascularised recepient bed, complications and failure rate increase and solution often lies in amputation. Vascularised ipsilateral fibular grafting offers a viable alternative to this. This is a series of 16 cases of gap non-union of tibia treated by tibialisation of fibula at KEM Hospital, Bombay. All the cases were secondary to osteomyelitis following compound fracture of tibia-fibula or hematogenous osteomyelitis with a large sequestrum. 15 cases had good results with good hypertrophy of bone after union. One case had poor result with fracture going into delayed union with no hypertrophy. We discuss the technique, complications and results of this procedure.