Total hip arthroplasty in sickle cell disease patients in a developing country

Background

Osteoarthritis secondary to osteonecrosis of the femoral head is a common presentation in patients with sickle cell disease. Functional limitations with or without deformities from these complications of sickle cell disease often require Total Hip Arthroplasty (THA) to improve outcome.

Aim

The aim of this study was to evaluate the postoperative outcome of THA for secondary osteoarthritis from osteonecrosis of the head of the femur in patients with sickle cell disease. Methodology: A retrospective study of outcome of THA in sickle cell disease patients between January 2010 and December 2015 is presented. Primary outcome was measured using the rates of complications and the Harris Hip scores at 6 weeks, 12 weeks, 6 months, and yearly.

Results

A total of 68 THA in 56 patients with sickle cell disease was reviewed. The age range was 13-68 years, with a mean of 30.9 years. There were 15 males and 41 females (M: F ratio = 1:3). Approaches to the hip were direct lateral (64.3%), anterolateral (1.8%), and posterior (33.9%). 12 (21.4%) patients had bilateral total hip arthroplasty, and 44 (78.6%) had unilateral total hip arthroplasty. No patient required adductor tenotomy. Superficial surgical site infection was recorded in 7 (12.5%) patients. The postoperative functional outcome, measured by the Harris Hip score, was good or excellent in all patients, except 2 (2.9%) who required revision surgery following unacceptable results after primary hip arthroplasty.

Conclusion

THA is a viable and effective treatment modality for sickle cell disease patients with osteonecrosis and secondary hip osteoarthritis. The choice of surgical approach does not affect the outcome.

Desorption, partitioning, and dechlorination characteristics of PCBs in sediments in interaction with reactive activated carbon

Sediment (WHS) in Waukegan Harbor, Illinois, heavily contaminated and aged with polychlorinated biphenyls (PCBs), was treated with reactive activated carbon (RAC) impregnated with palladized iron nanoparticles. Lab test proceeded in a direct mixing configuration of RAC and WHS. A compartment configuration, where RAC was physically separated from WHS, was also designed to trace the sequential transport and fate of PCBs, including desorption, adsorption, dechlorination, and re-partitioning. PCBs, once desorbed from WHS, were immediately sequestrated to RAC and subject to dechlorination. Direct mixing of WHS with RAC was one-order of magnitude more effective for dechlorination than compartment configuration. Compared to their desorption-followed by-adsorption route, direct physical contact of RAC with PCBs bound to WHS exhibited negligible contribution to the availability of PCBs for dechlorination reaction. Addition of RAC even in compartment configuration facilitated PCBs desorption from WHS. However, slow desorption of PCBs limited overall performance, resulting in a five-order of magnitude lower dechlorination yield when compared with treatment of purely aqueous PCBs. The low dechlorination yield reflected real world complexities in treating 3.19% organic carbon-containing WHS aged with PCBs for 40 years. These observations were further supported when compared with results on clean Cesar Creek sediment spiked with 2-chlorinated biphenyls.