Aims

A revision for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) has a major effect on the patient’s quality of life, including walking capacity. The objective of this case control study was to investigate the histological and ultrastructural changes to the gluteus medius tendon (GMED) in patients revised due to a PJI, and to compare it with revision THAs without infection performed using the same lateral approach.

Health care facilities are major contributors of waste to landfills, with operating rooms estimated to assume 20–70% of this waste. With hip arthroscopy for femoroacetabular impingement (FAI) on the rise, it is important to understand its environmental impact and identify areas for greening practices. Given its minimally-invasive nature, we hypothesise overall arthroscopic waste per FAI patient case to be approximately 5 kg, with minimal biohazard waste. The purpose of this study was to determine the amount of waste produced in FAI procedures and understand the environmental impact of the procedure to aid us in developing greening practices.

A single surgeon waste audit (with descriptive statistics) of five FAI hip arthroscopy procedures – categorised by: 1) normal/landfill waste; 2) recyclable cardboards and plastics; 3) biohazard waste; 4) sharp items; 5) linens; and 6) sterile wrapping – was performed in April 2015.

The surgical waste (except laundered linens) from the five FAI surgeries totalled 47.4 kg, of which 21.7 kg (45.7%) was biohazard waste, 11.7 kg (24.6%) was sterile wrap, 6.4 kg (13.5%) was normal/landfill waste, 6.4 kg (13.5%) was recyclable plastics, and 1.2 kg (2.6%) was sharp items. There was an average of 9.4 kg (excluding laundered linens) of waste produced per procedure.

Considerable waste, specifically biohazard waste, is produced in FAI procedures with an average of 9.4 kg of waste produced per procedure, including 4.3 kg of biohazard waste. In Canada (population 35.7 million), approximately 18 800 kg of waste (8600 kg of biohazard waste) is produced from an estimated 2000 FAI procedures performed every year. Additional recycling programs, reducing surgical overage, and continued adherence to proper waste segregation will be helpful in reducing waste production and its environmental burden. An emphasis on “green outcomes” is also required to demonstrate environmental responsibility and effectively manage and allocate finite resources.

Aims: We used dynamic radiostereometry (RSA) to record the kinematics of knee with medial arthritis during active extension and weight bearing. Methods: 15 patients with medial knee arthrosis (OA) and 10 controls were studied. The knee motions were recorded using 2–4 sequential simultaneous exposures/s when the subjects ascended a platform. Each series constituted 10 exposures (range 5–15) exposed during 3–5 s. Translations of the circular centre of the medial (MFFC) and lateral (LFFC) femoral condyles and of the tibial plateau centre were computed separately. Repeated measure ANOVA was used. Results: In the OA group the tibia was rotated 4.6û less internally at 50û exion,ßwhich changed to 2.1û less internally at 20û compared with the controls (p=0.035). The LFFC displaced 0.8 mm anteriorly in the OA group and 1.5 mm posteriorly in the normal knees (p=0.046). It displaced 0.6 mm distally in the OA and 0.5 mm proximally in the normal knees (p=0.007). MFFC showed nearly no proximal/distal translation in the OA knees. It displaced 1.6 mm proximally p< 0.0005) in the normal knees. The tibial plateau center shifted 3.5 mm less anteriorly and 2.4 mm less distally than in the OA group (p=0.000). Conclusion: The changed tibial rotations and anterior/posterior translations of both the lateral femoral condyle and the tibial plateau center showed similarities to cases with rupture of the ACL. It might be that the patients with medial arthrosis actively avoided internal rotation to decrease pain or the ACL had lost its function due to degenerative changes. The difference in proximal/distal displacement might be related to loss of cartilage in the medial compartment.