Waste disposal is an issue that affects us all. Medical waste disposal has posed even more difficulties with the appearance of needles, syringes, and other similar items on our beaches. The amount and toxicity of medical waste has increased in line with increasing medical facilities and diagnostic and therapeutic procedures. Demand for landfill sites and increasing household and hospital waste loads, have made the current situation untenable. New thinking and new strategies must be employed. There is significant waste production in the operating department during a primary total hip arthroplasty. A prospective observational study of the waste from packaging and non-clinical materials in consecutive total hip replacements was undertaken. The total weight and volume of waste, the cost of disposal and percentage of recycled items were recorded for each case. Inappropriate segregation of waste was recorded and the hazards involved are discussed. Reduce, Reuse and Recycle are the cornerstones of waste management. Medical staff need to understand how best to segregate waste and take advantage of opportunities for reuse and recycling. We must revisit the packaging of implants, the use of recycled paper. We did not inherit our environment from our parents; we are only minding it for our children.
An analysis of the cement mantle obtained with the Exeter impaction allografting system at one centre showed that it was either deficient or absent in almost 47% of Gruen zones. We therefore examined the mantle obtained using this system at another hospital and compared the results with those from the CPT and Harris Precoat Systems at other centres. The surgical indications for the procedure and the patient details were broadly similar in all four hospitals. There was some variation in the frequency of use of cortical strut allografts, cerclage wires and wire mesh to supplement the impaction allograft. Analysis of the cement mantles showed that when uncertain Gruen zones were excluded, the incidence of zones with areas of absence or deficiency of the cement was 47% and 50%, respectively, for the two centres using the Exeter system, 21% for the CPT system and 18% for the Harris Precoat system. We measured the difference in size between the proximal allograft impactors and the definitive prosthesis for each system. The Exeter system impactors are shorter than the definitive prosthesis and taper sharply so that the cavity created is inadequate, especially distally. The CPT proximal impactors are considerably longer than the definitive prosthesis and are designed to give a mantle of approximately 2 mm medially and laterally and 1.5 mm anteriorly and posteriorly. The Harris Precoat proximal impactors allow for a mantle with a circumference of 0.75 mm in the smaller sizes and 1 mm in the larger. Many reports link the longevity of a cemented implant to the adequacy of the cement mantle. For this reason, femoral impaction systems require careful design to achieve a cement mantle which is uninterrupted in its length and adequate in its thickness. Our results suggest that some current systems require modification.
