Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
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Seeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\n
Over these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\n
We are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\n
Thank you all for being part of the journey. 5,000 times thank you!
\\n\\n
Now with 5,000 titles available Open Access, which one will you read next?
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
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"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\n
Seeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\n
Over these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\n
We are excited about the present, and we look forward to sharing many more successes in the future.
\n\n
Thank you all for being part of the journey. 5,000 times thank you!
\n\n
Now with 5,000 titles available Open Access, which one will you read next?
\n'}],latestNews:[{slug:"intechopen-partners-with-ehs-for-digital-advertising-representation-20210416",title:"IntechOpen Partners with EHS for Digital Advertising Representation"},{slug:"intechopen-signs-new-contract-with-cepiec-china-for-distribution-of-open-access-books-20210319",title:"IntechOpen Signs New Contract with CEPIEC, China for Distribution of Open Access Books"},{slug:"150-million-downloads-and-counting-20210316",title:"150 Million Downloads and Counting"},{slug:"intechopen-secures-indefinite-content-preservation-with-clockss-20210309",title:"IntechOpen Secures Indefinite Content Preservation with CLOCKSS"},{slug:"intechopen-expands-to-all-global-amazon-channels-with-full-catalog-of-books-20210308",title:"IntechOpen Expands to All Global Amazon Channels with Full Catalog of Books"},{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"}]},book:{item:{type:"book",id:"1420",leadTitle:null,fullTitle:"Geochemistry - Earth's System Processes",title:"Geochemistry",subtitle:"Earth's System Processes",reviewType:"peer-reviewed",abstract:"This book brings together the knowledge from a variety of topics within the field of geochemistry. The audience for this book consists of a multitude of scientists such as physicists, geologists, technologists, petroleum engineers, volcanologists, geochemists and government agencies. The topics represented facilitate as establishing a starting point for new ideas and further contributions. An effective management of geological and environmental issues requires the understanding of recent research in minerals, soil, ores, rocks, water, sediments. 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\r\n\tIdiopathic pulmonary fibrosis (IPF) is the most common and important type of Idiopathic interstitial pneumonia, characterized by progressive fibrosis. It is a serious disease of unknown etiology with a high fatality rate. Over the past two decades there has been a tremendous amount of research in this field, that has helped us better understand the epidemiology, risk factors, pathogenesis, diagnostic evaluation and management strategies of IPF. The incidence and prevalence of the disease increases with age.
\r\n
\r\n\tWorldwide IPF has known to affect more than 3 million people. In US the reported incidence of IPF is 6 to 94 cases per 100,000 person years and prevalence is 18-495 cases per 100,000 adults depending on the age of the cohort. IPF is a clinically heterogenous disease and the course and progression of IPF is highly variable with intermittent episodes of acute exacerbations with rapid decline in lung function. Patients present with dyspnea and hypoxemia which significantly affects their quality of life. IPF is an expensive disease and the direct treatment cost is around 25,000 USD per person year. The pathogenesis of the disease is complex, and it is important to rule out a number of other diseases that can lead to pulmonary fibrosis. The hallmark of this disease is usual interstitial pneumonia (UIP) pattern seen on HRCT and on histology.
\r\n
\r\n\tThe diagnosis requires a multidisciplinary team approach and several guidelines have been published in the recent years to help the clinicians diagnose this disease in a timely manner. After decades of research two antifibrotic drugs are now available which are not curative but has shown to significantly slow down the decline in lung function associated with this disease. There are newer and less invasive technologies, biomarkers that are being developed to diagnose IPF and novel targeted treatment strategies are on pipeline. Lung transplant still remains the cornerstone of management as despite the treatment with antifibrotic agents most of the patients with IPF will progress to advanced end-stage lung disease.
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1. Introduction
The Republic of Guinea is rich in natural resources yet, since its independence in 1958, has struggled to transform that advantage into durable economic and social development. The small country has over a quarter of the world’s proven bauxite reserves, approximately 7.4 billion metric tonnes (t) [1, 2], more than any other nation. Bauxite is the primary ore used to produce aluminum; aluminum alloys are used to manufacture countless items around the globe. Still, Guinea’s bauxite mining industry did not grow substantially between the 1960s and 2015 [3]. Thus, Guinea’s government [4], along with the World Bank [5], African Development Bank [4, 6], and others [7], has identified Guinea’s mining sector with economic growth, infrastructure development, poverty reduction, and social well-being. Recently, foreign direct investment (FDI) has fueled dramatic increases in Guinea’s bauxite-aluminum industry (Figure 1). This growth presents new challenges as governments and industries worldwide have focused more and more on (GHG) emissions and climate adaptation strategies. Notably, Guinea formalized a commitment to the United Nations Framework Convention on Climate Change (UNFCCC) by publishing its intended national development goals (INDCs) and sustainable development strategy priorities [4] in 2015.
Figure 1.
Rise of Guinea’s mining sector.
Like most developing countries, Guinea lacks capacity to meet its INDCs alone. Recognizing this widespread need, UNFCCC created the Green Climate Fund (GCF) as a mechanism to encourage climate change adaptation and mitigation by matching private sector investment funds. The GCF’s eligibility requirements are quite strict, and programmatic assistance is often needed to qualify. Hence, in 2016 Guinea requested and received a GCF Readiness Programme grant to help build its capacity. The UNDP, an accredited partner of the GCF [8], led Guinea’s Readiness Programme and, as part of capacity building, sought out Columbia University to develop tools to engage Guinea’s private sector in sustainable mining practices. This chapter summarizes that project’s conceptualization, methods, and results, including generalized insights into public-private collaborations. The Readiness Programme wrapped up in December 2018 with Guinea’s National Designated Authority established and prepared to articulate initiatives, mobilize private sector engagement, and develop a robust GCF Country Programme plan. Thus, Guinea is now fully equipped to access the GCF funding.
1.1 Conspicuous sustainability resources
The UN’s Sustainable Development Goals (SDGs) 8, 9, 11, and 17 integrate responsible resource extraction regimes into sustainable development. At present, a confluence of factors—new mining concessions, presidential agenda, civil society organization activity in the mining regions, and not least of all the GCF matching funding—has created opportunities to solidify sustainable mining practices. UNDP-Guinea’s decision to ask Columbia University for support with this acutely relevant work underpins the notion that student-based research can be an effective impetus to useful and compelling outcomes when it is backed by in-depth involvement of seasoned researchers like Widder and Pacioni, on-site face-to-face interactions, and a commitment to collaboration. This project fostered genuine engagement from stakeholders in industry, government, and local NGOs by uncovering pathways to influence local technical approaches, regional development, and national policy. Because the project was objective and academic, leveraging resources not typically available (e.g., Columbia University’s degree programs in sustainability), its approach offers a unique methodological reference.
1.2 Economic, environmental, and social context
The seemingly dissonant condition of abundant natural resources coupled with highly limited economic and social development is not uncommon in West Africa [6]. The challenge of remedying that deeply rooted condition is daunting because economic development, social development, and environmental protection are overlapping and often conflicting components in a highly complex system (i.e., sustainable development). To help determine needs, the UNDP calculates a Human Development Index (HDI) based on inputs including life expectancy, education, and per capita income. Of UN’s 189 member nations, Guinea’s HDI ranks 175 [9]. In fact, all West African nations are ranked in the lowest quartile. To vitalize sustainable development in Guinea, UNDP-Guinea focuses specifically on poverty reduction, climate change risk, and peace building and governance [10].
With a population of 12.7 M [11], Guinea ranks among the world’s least developed in infrastructure [12] and, until very recently, FDI [13]. However, in a remarkable change from decades of economic stagnation, gross domestic product (GDP) rose 10+% in both 2016 and 2017, largely due to mining sector expansion [13, 14]. In accordance with its strategic plan [4], Guinea’s Ministry of Mines and Geology actively developed new concessions and promulgated a special economic zone (SEZ) for the Boké Region in 2017, underscoring its importance to the bauxite-aluminum industry. Of particular note, the bauxite-aluminum industry’s current boom is borne largely of FDI from China [15], the UAE [16], Russia [17], and, to a lesser extent, Iran [18], France [19], the USA [20], the UK, Australia, India, and the Netherlands in joint ventures with federal ownership. Moreover, a consortium of mining companies funded a new trade organization, Guinea’s Chamber of Mines, to communicate and represent private mining sector interests.
As the World Bank describes in its report on Guinea’s mining sector, the bauxite industry’s need for infrastructure offers crucial potential for industrialization and service sector development [14]. For example, recent investment in rail transport from Guinea’s mining hub in the Boké Region to its commercial port originated in the private sector working through the Chamber of Mines. Potentials for the transportation and service sectors to provide local employment exceed that of the largely automated mining industry, especially if that development is part of a regional network linking nearby landlocked economies to Guinea’s port. In fact, Guinea’s abundant waterways and other freshwater assets have high regional importance and must be part of any sustainable development plan. Nonetheless, difficulties remain in defining and enacting mechanisms to distribute the mining sector’s benefits and to enact good governance, community enhancement, and environmental mitigation.
1.3 Regulatory and policy context
A lack of transparency about mining concessions and practices, poor communication with communities impacted, inadequate or poorly timed remuneration for agricultural land, and the tendency among foreign mining companies to import everything from power plants and fuel to workers from their home countries have led to civil unrest, especially in the Boké Region [21]. Riots, destruction of property, and disruption of electrical and transportation infrastructure hobble extraction and threaten its continued build-out.
Although regulations requiring environmental impact reports are in place, Guinea’s Ministry of Environment is underfunded and underequipped to monitor and enforce industry commitments [22]. A recent Human Rights Watch report [22] illustrates impacts of poorly enforced regulation on farmers’ livelihoods, civil society, and citizen confidence. Reports of waterway degradation from dust released during open-pit mining suggest that the current boom is adversely impacting fisheries, mostly practiced at artisanal scale, which is the country’s other primary employment sector [23]. Because Guinea encompasses the source and/or course of nearly all major West African rivers, any water quality or flow degradation will have considerable regional ramifications. Further, these impacts will have a compounding negative effect on region-wide ecosystems as underscored by independent climate change models predicting increased desertification in West Africa [14], especially in the transition zone between the Sahara Desert and the southern savanna (i.e., Sahel).
1.4 Current funding mechanisms
After clarifying Guinea’s willingness to meet its responsibilities under the UNFCCC’s Paris Accord, UNDP-Guinea turned its attention to the bauxite-aluminum industry because it has overwhelming bearing on Guinea’s sustainable development and because it is among the few industries with the capacities to co-finance GCF projects. Currently mining companies are required to pay a small proportion of their profits as a “royalty” intended for use in federal remediation projects. Although mining companies may see the benefits of addressing the cumulative impacts of their activities, this mining royalty modality, the primary modality for participation, is not sufficiently robust. Existing mechanisms designed to ensure effective application of legal and regulatory instruments for mining development are very weak and constitute a hindrance for crowding in private sector investment.
However, one might find opportunity rather than conflict where mining investment and civil society participation intersect. This study landed on the concept of “shared use” to describe these synergies (described below). Accordingly, and as a direct result of the collaborative activities described, UNDP-Guinea is developing a work scope for integrated management of the coastal region that has been impacted by mining activities and erosion, with co-financing of USD 11 M from the GCF and the Chamber of Mines. This demonstrates how the GCF created opportunity to couple Guinea’s rapid industrialization to its INDCs.
2. Project design
2.1 Objectives
The overarching project objective was to engage Guinea’s private-sector mining companies in productive dialog regarding sustainable mining practices, both current and future. Specific goals included the following: (a) identify public-sector stakeholders that could champion sustainability-based initiatives and private-sector stakeholders with expertise in sustainable mining practices; (b) determine the industry’s current direct GHG emissions and potential impacts from near-term industry growth; (c) in light of enormous pressure to expand, identify perceived and actual barriers to sector growth and perceived barriers to more sustainable practices; (d) describe proven best practices for sustainability in mining that are applicable and appropriate in Guinea; (e) assist in positioning the mining sector to help meet Guinea’s INDCs and to access new forms of capital (e.g., GCF); and (f) provide UNDP-Guinea a model for implementing such initiatives in the future.
Columbia’s conceptual approach was threefold: (1) establish credibility with private- and public-sector stakeholders; (2) develop an unbiased overview of the industry’s likely or typical operations, challenges, risks, and opportunities relative to environmental and social conditions; and (3) share pragmatic approaches to sustainable mining in a face-to-face forum to (i) enhance Guinea’s knowledge base, (ii) elicit industry feedback on specific tactics used currently and challenges foreseen, and (iii) leverage dialog to form a collaborative effort among stakeholders to share knowledge and to focus on achievable sustainability goals.
2.2 Scope and methods
In spring 2018, Dr. Lynnette Widder, a Columbia University professor of sustainable development and urbanism, assembled a team that included technical advisor Thomas D. Pacioni whose decades-long experience in extractives and advanced degrees in geology and sustainability management equipped him to guide research and analysis and four graduate students recruited based on academic performance from Columbia’s Master’s Degree programs in Sustainability Management and in Public Administration and Development [24]. UNDP-Guinea committed to monitor progress and facilitate communication with Guinean organizations, and their operational support and strategic input proved invaluable. The work scope was modeled on the GCF’s 2015 Readiness Proposal for Guinea [25] and was completed in two distinct phases. Columbia’s research team initially completed:
Literature reviews on (a) Guinea’s current and planned capacity expansion of bauxite-aluminum operations; (b) inputs, outputs, throughput volumes, and potential sustainability impacts from operations; (c) typical GHG emission factors correlated to production; (d) standards and guidelines used elsewhere that could be adapted to Guinea; and (e) successful implementation of sustainability practices in bauxite mining under environmental and social conditions similar to Guinea’s.
Interviews with mining industry insiders with expertise in environmental, social, and governance (ESG) practices, financing capital projects in international extractives, and Guinea’s regulators, including: a representative of the International Council on Mining and Metals (ICMM), a biodiversity consultant working in Guinea’s mining sector, International Finance Corporation (IFC), Power Africa (a USAID program), an independent consultant, Columbia’s Center for Sustainable Investment (CCSI), Guinea’s Ministry of Energy and Water Resources, and Electricité de Guinée.
GHG emissions were estimated for (a) current actual bauxite volumes reported; and (b) near-term future conditions based on conservative estimates of published expansion plans.
Case studies were selected that (a) apply directly to Guinea’s bauxite mining conditions; (b) mitigate effectively and realistically a spectrum of sustainability risks; (c) cross-reference industry standards; (d) incentivize action on environmental and social performance; and (e) could facilitate knowledge sharing and initiate a dialog with Guinea’s mining companies, leading to future collaborative data gathering and discussion of best practices.
Subsequent to Phase 1, and with facilitation support from UNDP-Guinea’s Ousmane Bocoum, Widder and Pacioni expanded work on qualitative and quantitative drivers that included (a) field-based research in Guinea to isolate data gaps and to verify and/or update Phase 1 data; (b) interviewing executives from Guinea’s Chamber of Mines and UNDP-Guinea’s local ESG programs, in part to gain insight into the relationships among mining’s actual (i.e., on-the-ground) environmental and social drivers; (c) beginning to explore methodologies for developing shared infrastructure in transportation and energy that can benefit communities and private-sector stakeholders durably; (d) developing an advocacy strategy to prove how sustainability-based best practices will reduce intense social pressures by expressing a longer-term growth approach that includes generational community needs, not only annual revenues; (e) leveraging a recently created consortium of bauxite mining companies in the Boké Region dedicated to cross-border biodiversity to disseminate and access critical data; and (f) leading a workshop to share sustainable findings and support collaboration and/or friendly competition among bauxite mining companies in Guinea.
2.3 Limitations
The study was not comprehensive in scope but instead was limited to readily available data. Although financing mechanisms were discussed, neither a detailed financial analysis nor a review of potential capitalization strategies was completed. Rather, the results of a non-funded academic exercise were expanded in the hope that tangible progress in private-sector engagement could further the UNDP/GCF’s Readiness Programme.
3. Academia’s POV: benefits and value
Although the benefits of university research to policy makers are well established, less attention has been given to the role that academic coursework can play. For this project, UNDP-Guinea prioritized academic objectivity. This relationship allowed the team of students and faculty to retain full academic freedom, to conceptualize the project’s scope, and to reframe questions as warranted by iterative research results.
The team’s independent position translated into access to subject-matter experts who might otherwise have treated their knowledge as proprietary, including international trade organizations, industry representatives, independent finance and science consultants, development aid organizations, and researchers from other academic institutions. Because the workshop format of the research project led to broad-based action items, Guinea’s bauxite-aluminum industry representatives and regulators could consider its outcomes without concerns about conflicting agendas.
4. Production processes
Bauxite, a sedimentary rock, is the primary ore used to produce aluminum. In turn, aluminum alloys are widely used [26] to manufacture all types of vehicles, mobile phones and electronics, machinery, building construction materials, and household items. Transforming bauxite into aluminum is a three-step industrial process (Figure 2), each step having social and environmental impacts (e.g., GHG emissions). Based on typical worldwide production data, approximately 5.54 t of extracted bauxite will produce 2.25 t of alumina which, in turn, will produce 1 t of aluminum [27].
Figure 2.
Bauxite-aluminum process steps.
4.1 Bauxite-aluminum production
Bauxite mining—In Guinea, bauxite is mined from open pits, crushed, and washed on site with water to reduce dust and remove some impurities. The material is then screened and dried, producing beneficiated bauxite and wastewater, and then transported to an alumina refinery. At most bauxite mines around the world, wastewater is retained in settling ponds for reuse [28]. This is likely true in Guinea; however, specific company practices are not publicly available. Most of Guinea’s beneficiated bauxite is shipped abroad for refining.
Alumina refining—Beneficiated bauxite is then refined into alumina (i.e., aluminum oxide, Al2O3) using the Bayer process, wherein hot caustic soda is added to dissolve the aluminum compounds. Insoluble residue (i.e., red mud) is then filtered out, and alumina is precipitated. The red mud is washed to recover as much caustic as practical and then disposed.
Aluminum smelting—Smelting (anode paste production, electrolysis, and ingot casting) is the process by which alumina is dissolved in sodium aluminum hexafluoride (cryolite) at 1,000°C and then placed in a cell with carbon (typically graphite) cathodes and anodes. Electrolysis oxidizes the anode’s carbon to carbon dioxide (CO2), and aluminum ions are reduced to aluminum metal at the cathode.
4.2 Resource use and impacts
Potential environmental impacts of bauxite-aluminum production include topsoil destruction, dust generation, overuse of freshwater supplies, wastewater releases, and GHG emissions. Resource inputs and non-GHG waste based on typical production data are summarized in Table 1, and qualitative summaries are provided below.
Bauxite mining (per t of bauxite ore extracted)
Alumina refining (per t of alumina refined)
Aluminum smelting* (per t of primary aluminum smelted)
Electrolysis process only, excludes anode production and ingot casting.
Bauxite mining—Mechanical mining causes dusty conditions, and airborne particulates are both a direct respiratory risk and the primary source of reddish deposits in the areas around. Energy inputs at this phase are mostly diesel used in bulldozers, excavators, and haul trucks. While Guinea’s mining wastewater may be recovered as a general practice, there are reports of surface water impacts [22]. This means wastewater management may not be adequate to protect Guinea’s all-important waterways.
Alumina refining—Refining requires substantially more water and electricity than mining. Disposed red mud is high in pH and salinity. In addition, metals and natural background radioactivity from its parent bauxite are often concentrated in red mud. Although there are potential uses for red mud, the international rate of reuse is only 2–3% [32]. Other by-products of alumina refining include hydrocarbons, suspended solids in water, and air emissions of nitrogen dioxide, sulfur dioxide, and mercury [28, 30]. Thus, risks to human health and surrounding ecosystems from alumina refining [33] dramatically eclipses.
Aluminum smelting—Smelting requires yet another order of magnitude increase in energy input. Water requirements are also significantly greater than mining or alumina refining. Smelting also produces air emissions of fluorides and hydrocarbons [28].
5. Guinea’s bauxite-aluminum industry
Figure 3 shows the location and number of concessions, or permits to operate, for bauxite mining and alumina refining. Mining is largely centered in northwestern Guinea in the Boké Region’s SEZ. The majority of concessions are held in whole or in part by foreign mining organizations that have incorporated Guinean operating companies in conjunction with the Republic of Guinea’s government. Through 2015, Compagnie des Bauxites de Guinée (CBG, a.k.a. Guinea Bauxite Company) accounted for >75% of extracted bauxite. Guinea’s government holds a 49% interest in CBG, with the balance held by an international consortium. The remaining 20–25% of Guinea’s bauxite industry prior to 2016 was controlled by Russia’s RUSAL, operating three wholly owned subsidiaries. Large-scale growth began in 2015 (primarily) by expanding existing concessions and granting new concessions, with new mining operations coming on line in 2016. Guinea’s government controls 10–15% of most of the new concessions.
Figure 3.
Location of Guinea’s bauxite-aluminum concessions.
5.1 Current bauxite-aluminum production
Bauxite production for 2008–2018 (estimated) is provided in Table 2, and a summary of mining companies operating in Guinea is provided in Appendix A. Despite more than a half-century of bauxite mining, only one alumina refinery has been established in Guinea and its operation has been sporadic and largely inconsequential. No smelters have yet been constructed.
Although it does not integrate water pollution, soil pollution, or other types of air pollution relevant to the funding opportunities offered by the GCF, GHG emissions is the primary metric used to determine climate mitigation and adaptation needs. For the purpose of calculating conservative GHG estimates, the proportion of hydroelectric power in the industry’s overall energy mix was assumed to be consistent with regional averages in Africa (i.e., 43% [34]), compared to Guinea’s actual proportion of hydroelectric power, approximately 56% [35]. This GHG analysis only considered the industry’s current direct emissions, and not secondary emissions from transportation between facilities or to end users. GHG emissions are expressed throughout this chapter as t of CO2 equivalents or tCO2e. Table 2 and Figure 4 summarize annual bauxite-aluminum production and GHG emissions for 2008–2018. Emission factors (EFs) used to calculate GHG emissions for each step in the aluminum production process are summarized in Table 3. EFs are provided per t of material produced in each step and per t of aluminum produced across each step. To determine EFs, the relative proportions of material required to produce 1 t of aluminum (described in Section 4) were assumed.
Consistent with Guinea’s strategic plan, bauxite production has increased rapidly since 2016. Guinea’s alumina refinery had not been operating, so recent GHG emissions were negligible, though refining resumed in early 2018.
5.3 Expansion plans and future GHG emissions
Since 2015 Guinea’s government has consistently signaled strong interest in expanding bauxite mining, as well as in-country alumina refining and aluminum smelting. Specifically, all new mining concessions have included rights for alumina refineries, most notably a USD 2.8 B investment from the Chinese company TBEA [36]. TBEA plans to bring its alumina refinery online by June 2021 and to start smelter construction by 2025. (Because TBEA’s concession is not yet available, it is not included in Appendix A). In addition to private-sector funds, the World Bank’s [37] investment matching program has facilitated the mining industry’s rapid expansion. Guinea’s stated goal is to grow extraction refining from 0.6 to >1 Mt by 2024 [38], thereby boosting GDP and generating considerable demand for local employment, though it is not clear that local workers will benefit from these new concessions. More concerning than the lack of transparency about staffing plans in these new concessions is the extraordinary increase in GHG emissions that will accompany alumina and aluminum productions (Figure 4). The likely impact on near-term GHG emissions is shown in Figure 5.
Figure 5.
Future GHG emissions.
5.4 Regulations and standards
International, sectorial, and industry standards can ensure that mining companies follow best practices, especially if mutual monitoring by competing bauxite companies of one another’s compliance was embedded in compliance plans. The Guinea Sustainable Bauxite Mining Consortium, founded as a vehicle for GCF support, is one such opportunity. Additional standards are published by the IFC, the ICMM, the Aluminum Stewardship Initiative (ASI), and the Business and Biodiversity Offsets Programme (BBOP). However, because few of the companies operating in Guinea are publicly traded and therefore less likely to feel pressure from shareholders regarding accurate and timely environmental reporting, consensual oversight among peer companies is particularly important. Guinea’s laws and industry guidelines include provisions and methods for rehabilitating exhausted mines with local collaboration [39]. However, this has had limited success in the Boké Region [22].
6. A shared values approach to solutions
Given limitations on Guinea’s capacity to enforce its regulatory requirements and to create transparency around the environmental impact assessments required by law, it was prudent to look to other, less conventional pathways to help prioritize mining and refining processes that will decrease the magnitude of environmental and community damage. Conflict around competing resource needs is inevitable unless synergies and compromise are integrated. This points to consideration of shared values, an approach that has already realized rail and port improvement co-funded by mining companies.
With collaboration, Guinea’s hydropower potential may be used to leapfrog GHG impacts while also benefiting underserved rural communities. Guinea is the source of at least a dozen major West African rivers and a similar number of regional rivers, and could potentially generate 19,300-26,000 GWh of hydropower annually [35, 40]. The present installed capacity, subject to considerable seasonal fluctuation, is 0.5–0.6 GW [41]. Still, rural electrification is less than half the national average (11 vs. 26%). System build-out in which the bauxite industry can serve as an anchor client coupled with careful planning and monitoring to ensure biodiversity and waterway health could provide enormous national and regional benefit in perpetuity.
6.1 From shared use to shared solutions: a successful workshop
On June 29, 2018, the results from both phases of this study were presented in a workshop chaired by the Chamber of Mines with extensive participation from mining companies and organizations (Table 4). Stakeholders applauded UNDP-Guinea and Columbia University and described the workshop to Mr. Ousmane Bocoum (UNDP-Guinea, June 29, 2018) as “solutions served on a plate”. Debate on best practices inspired mining companies to discuss remediation strategies they are already practicing, making public efforts already underway (because they privately held, mining companies in Guinea have neither shareholder reporting nor robust corporate social responsibility reports). The workshop culminated in discussions on the benefits that mining companies would gain by more extensive knowledge sharing among companies, and how that knowledge sharing would help reach sustainability goals.
Mining companies and trade organizations: Chambre des Mines de Guinée, Alliance Minière Responsable (AMR), Alliance Mining Commodities (AMC), Alufer Mining, Compagnie des Bauxites de Guinée (CBG), Emirates Global Aluminum (EGA), Société Minière de Boké (SMB)
Academia: Columbia University - The Earth Institute, L’Université Gamal Abdel Nasser de Conakry-Centre d’Etude et de Recherche en Environnement (UGANC-CERE)
Nongovernmental organizations: Green Climate Fund, UNDP-Guinea, United Nations Children’s Fund (UNICEF)
Guinean government ministries: Ministry of Mines and Geology, Ministry of Environment
Table 4.
Workshop participants.
English translations of organizational names are provided in Appendix A.
6.2 Case studies
6.3 Strategy and benefits
UNDP-Guinea is now working with the Chamber of Mines on operationalizing their intention to adopt specific sustainable mining practices. This strategic momentum is timely because a landmark 2019 US Supreme Court decision in Jam v. IFC exposes the World Bank’s liability when financing negligent projects and promises to add pressure from civilian advocates. As an example, a suit has already been brought by 13 Guinean communities against the IFC for its support of mining projects, thus highlighting the immediate effect of the court’s decision. Coincidently, only days later, three major French banks announced their financing for the largest bauxite mining operation on the planet in Guinea [42]. As pressures to address increasingly empowered stakeholders grow, new pathways for investing in environmental and community sustainability gain much-needed traction.
6.4 Developments toward sustainable mining since project completion
Coastal mangrove rice growing has been impacted by bauxite dust released during mining. As a first step in providing opportunities for mining companies to engage in meaningful climate adaptation activities, the GCF recently approved a proposal for “Enhancing the Resilience of Guinea’s Coastal Rural Communities to Coastal Erosion Due to Climate Change” (see Section 4). This proposal, submitted by UNDP-Guinea and the Chamber of Mines, represents a milestone achievement in advancing Guinea’s SDG agenda beyond mandated royalties. Specifically, the Chamber of Mines pledged mining company investment to implement a paradigm-shifting adaptation solution based on (a) design and adoption of an integrated coastal zone management plan; (b) a tailored combination of ecosystem-based adaptation activities, including mangrove restoration and infrastructure for coastal protection; and (c) promotion of climate-resilient livelihoods among rural communities as a buffer against climate change risk and as incentive to preserve the mangrove ecosystem.
7. Conclusions
The experience of this 6-month engagement offers replicable values:
Academia has a valuable role to play by virtue of expertise (Widder and Pacioni), objectivity, ability to ask questions that others cannot due to expectations in their deliverables, and access to talented labor (i.e., graduate students).
Best practices can be shared and adapted—the companies operating in Guinea should share best practices and adapt others from comparable situations to conserve resources, engage community, and support the environment.
Research is a shared value—measuring environmental health, resources, flows, and community well-being is an opportunity for collaboration between universities and industry and will facilitate standards compliance.
Standards for sustainability—consensus around international standards ensures social license to operate, improved process efficiencies, resource savings, and funding opportunities for projects with multiple beneficiaries.
Acknowledgments
Cecilia Coates, Dolores De La Cruz, and Ellen Griesemer (Columbia University, Sustainability Management MS, 2018) and Micah Cruz (Columbia University, Sustainable Development MPA, 2018)
Sophie Dejonckheere (Senter for Internasjonal Klimaforskning), Claudia Ortiz (UNDP), and Lionel Laurens (UNDP-Guinea Country Director)
Luc Dejonckheere (Azimuth Advisory Services), Perrine Toledano (CCSI), Olga Puntus (IFC), Chris McCombe (ICMM), Dr. Rockfeler Herisse (USAID), Benoit Limoges (Réseau Environnement Bauxite), Charles Balamou (Electricité de Guinée), Chaïkou Yaya Diallo (Chambre des Mines de Guinée), and Mr. Barry (CBG)
Professor Kandey Bangoura (Scientific Research Center of Conakry Rogbane, CERESCOR) and Elias Ayu (UN University)
Conflict of interest
An evaluation of potential conflicts of interest that could influence the scientific work described herein, including but not limited to financial, personal, and/or commercial conflicts of interest, was completed for each author and co-author of this manuscript. No conflicts of interest were identified.
A. Appendices: Guinea’s bauxite mining operations
Company name
Controlling interest
Guinea interest (%)
Location
Concession type
CBG
Compagnie des Bauxites de Guinée
USA, Australia, UK (51% Halco: Alcoa, Rio Tinto-Alcan, Dadco)
49
Boké Rgn
Bauxite, alumina
a.k.a. Guinea Bauxite Company
also party to CBG/GAC joint agreement
Bauxite, alumina
Fria
RUSAL (using three separate operating cos)
Russia (48.1% of RUSAL is owned by En + Group
0
d.b.a. Alumina Company of Guinea
Fria Prf, Boké Rgn
Bauxite, alumina
CBK
d.b.a. Compagnie des Bauxites de Kindia
Kindia Prf/Rgn
Bauxite, Alumina
a.k.a. Kindia Bauxite Company
COBAD
d.b.a. Compagnie de Bauxiteet d’Aluminie de Diandian
Boké Rgn
Bauxite, alumina
a.k.a. Dian Bauxite Company
EGA
Emirates Global Aluminum
UAE
0
Boké Rgn
Bauxite, alumina, aluminum
GAC
d.b.a. Guinea Alumina Corp
f.k.a. Global Alumina Corp
CDM
China Henan International Mining Development Group
China (41% Chico, 51% Y’ngc’g C’l Elec, 8% Henan)
0
Boffa Prf, Boké Rgn
Bauxite, aluminum
CPI
China Power Investment Corporation
China
0
Boffa Prf, Boké Rgn
Bauxite, alumina
a.k.a. CPI Boffa Alumina
CHALCO
Aluminum Corporation of China Ltd.
China
0
Boffa Prf, Boké Rgn
Bauxite
d.b.a. Chalco Guinea Company
a.k.a. Chalco Hong Kong Ltd.
SBG
Metalcorp Group B.V.
The Netherlands (76.1% Metalcorp)
23.9
Kindia Rgn
Bauxite, alumina
d.b.a. Société des Bauxites de Guinée
a.k.a. SBG Bauxite and Alumina NV
a.k.a. Guinea Bauxite Corporation
SMB-WAP
Société Minière de Boké—Wining Port Afrique
China, Singapore, France (Shandong Weiqiao Al Pwr, Winning Ship’g, UMS)
10
Boké Rgn
Bauxite
a.k.a. Boké Mining Company
SBDT
Societe des Bauxites de Dabola-Tougue
Iran (51% SBDT)
49
Dabola and Tougué Prfs
Bauxite, alumina
AMC
Société Alliance Mining Commodities Guinée
Australia (90% AMC)
10
Gaoaul Prf, Boké Rgn
Bauxite
a.k.a. Alliance Mining Commodities Ltd.
Pella Ventures Limited
UK (85% Pella Ventures)
15
Boffa Prf, Boké Rgn
Bauxite
d.b.a. Alufer Mining
a.k.a. Bel Air Mining
AMR
Alliance Minière Responsible
France
Boké Rgn
Bauxite
a.k.a. Responsible Mining Alliance
Jaguar Overseas
India (50% Dynamic Mining)
50
Boké Rgn
Bauxite
d.b.a. Dynamic Mining
a.k.a. International Gulf ZFC
IMD
International Mining Development
Ireland
Fria Prf, Boké Rgn
Bauxite, alumina
a.k.a. Lissa Mining
\n',keywords:"Guinea, bauxite, aluminum, alumina refining, greenhouse gas emissions, GHG, sustainable mining, climate mitigation, climate adaptation, industrialization, regional investment, infrastructure, cumulative impacts, environment",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/69489.pdf",chapterXML:"https://mts.intechopen.com/source/xml/69489.xml",downloadPdfUrl:"/chapter/pdf-download/69489",previewPdfUrl:"/chapter/pdf-preview/69489",totalDownloads:363,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,dateSubmitted:"January 23rd 2019",dateReviewed:"April 23rd 2019",datePrePublished:"October 10th 2019",datePublished:"August 19th 2020",dateFinished:"October 10th 2019",readingETA:"0",abstract:"Guinea’s bauxite-aluminum industry is undergoing significant expansion of investment, concession agreements, and in-country mining and refining operations. In 2018, UNDP-Guinea and Columbia University developed a framework that would evaluate this development against metrics for social and environmental sustainability, such as energy access and diversification, water quality, land use, biodiversity restoration, waste management, and community engagement. Current environmental impacts measured in GHGs, a metric both economic and environmental, were compared to potential impacts anticipated as a consequence of expansion. These anticipated impacts include enormous increases in countrywide GHG emissions and significant regional shortfalls in access to electrical energy. Case studies from the international bauxite-aluminum industry were then used to illustrate best practices for climate mitigation and adaptation and to describe opportunities for regional collaboration on shared-use energy and infrastructure development (e.g., hydropower used across West Africa, rail transportation) while achieving measurable benefits to communities, NGOs, regulators, and mining companies.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/69489",risUrl:"/chapter/ris/69489",book:{slug:"regional-development-in-africa"},signatures:"Lynnette Widder, Thomas D. Pacioni and Ousmane Bocoum",authors:[{id:"292967",title:"Prof.",name:"Lynnette",middleName:null,surname:"Widder",fullName:"Lynnette Widder",slug:"lynnette-widder",email:"lw268@columbia.edu",position:null,institution:null},{id:"294811",title:"MSc.",name:"Thomas",middleName:null,surname:"Pacioni",fullName:"Thomas Pacioni",slug:"thomas-pacioni",email:"tdp2120@columbia.edu",position:null,institution:null},{id:"302170",title:"Prof.",name:"Ousmane",middleName:null,surname:"Bocoum",fullName:"Ousmane Bocoum",slug:"ousmane-bocoum",email:"ousmane.bocoum@undp.org",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1 Conspicuous sustainability resources",level:"2"},{id:"sec_2_2",title:"1.2 Economic, environmental, and social context",level:"2"},{id:"sec_3_2",title:"1.3 Regulatory and policy context",level:"2"},{id:"sec_4_2",title:"1.4 Current funding mechanisms",level:"2"},{id:"sec_6",title:"2. Project design",level:"1"},{id:"sec_6_2",title:"2.1 Objectives",level:"2"},{id:"sec_7_2",title:"2.2 Scope and methods",level:"2"},{id:"sec_8_2",title:"2.3 Limitations",level:"2"},{id:"sec_10",title:"3. Academia’s POV: benefits and value",level:"1"},{id:"sec_11",title:"4. Production processes",level:"1"},{id:"sec_11_2",title:"4.1 Bauxite-aluminum production",level:"2"},{id:"sec_12_2",title:"4.2 Resource use and impacts",level:"2"},{id:"sec_14",title:"5. Guinea’s bauxite-aluminum industry",level:"1"},{id:"sec_14_2",title:"5.1 Current bauxite-aluminum production",level:"2"},{id:"sec_15_2",title:"5.2 GHG emissions",level:"2"},{id:"sec_16_2",title:"5.3 Expansion plans and future GHG emissions",level:"2"},{id:"sec_17_2",title:"5.4 Regulations and standards",level:"2"},{id:"sec_19",title:"6. A shared values approach to solutions",level:"1"},{id:"sec_19_2",title:"6.1 From shared use to shared solutions: a successful workshop",level:"2"},{id:"sec_20_2",title:"6.2 Case studies",level:"2"},{id:"sec_21_2",title:"6.3 Strategy and benefits",level:"2"},{id:"sec_22_2",title:"6.4 Developments toward sustainable mining since project completion",level:"2"},{id:"sec_24",title:"7. Conclusions",level:"1"},{id:"sec_25",title:"Acknowledgments",level:"1"},{id:"sec_28",title:"Conflict of interest",level:"1"},{id:"sec_26",title:"A. Appendices: Guinea’s bauxite mining operations",level:"1"}],chapterReferences:[{id:"B1",body:'Renaud KM. The Mineral Industry of Guinea. In: US Geological Survey Minerals Yearbook 2016. 2018. Washington, DC: U.S. Geological Survey; p. 20.1. [Accessed: 02 April 2019]'},{id:"B2",body:'Bray EL. Bauxite and Alumina: US Geological Survey Mineral Commodity Summaries 2019. U.S. Geological Survey. 2019. p. 31. [Accessed: 01 April 2019]'},{id:"B3",body:'Statista. 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Columbia University, USA
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She is currently an associate professor at the University of Salamanca, Faculty of Education.\nThis training trajectory is combined with a wide and extensive experience, academic and professional, in the field of pedagogy: in planning agile methodologies and application of actions, based on the diagnosis of needs; in the organization and management of curricular and innovation projects, in improving the teaching and learning processes; in the design of personalized educational resources, educational technology, blended learning, etc.\nShe is the Academic Coordinator of the Training Program in the Entrepreneurship Chair at the University of Salamanca, a member of the Academic Committee for international postgraduate programs (masters) in Entrepreneurial Development and Innovation, and the National Secretary of the Network for Entrepreneurship Training, Research and Development.",institutionString:"University of Salamanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Salamanca",institutionURL:null,country:{name:"Spain"}}},equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"73366",title:"Organizational Insights, Challenges and Impact of Sustainable Development in Developing and Developed Nations",slug:"organizational-insights-challenges-and-impact-of-sustainable-development-in-developing-and-developed",signatures:"Katundu Imasiku",authors:[{id:"322704",title:"Dr.Ing.",name:"Katundu",middleName:null,surname:"Imasiku",fullName:"Katundu Imasiku",slug:"katundu-imasiku"}]},{id:"73406",title:"Workplace Innovation for Social Sustainable Development",slug:"workplace-innovation-for-social-sustainable-development",signatures:"Kassu Jilcha",authors:[{id:"292841",title:"Ph.D.",name:"Kassu",middleName:null,surname:"Jilcha Sileyew",fullName:"Kassu Jilcha Sileyew",slug:"kassu-jilcha-sileyew"}]},{id:"74334",title:"Entrepreneurial Momentum for Sustainable Growth",slug:"entrepreneurial-momentum-for-sustainable-growth",signatures:"Ihor Katernyak and Viktoriya Loboda",authors:[{id:"321708",title:"Ph.D.",name:"Ihor",middleName:null,surname:"Katernyak",fullName:"Ihor Katernyak",slug:"ihor-katernyak"},{id:"331224",title:"Prof.",name:"Viktoriya",middleName:null,surname:"Loboda",fullName:"Viktoriya Loboda",slug:"viktoriya-loboda"}]},{id:"73311",title:"Organizational Support and Sustainable Entrepreneurship Performance of SMEs, the Moderating Role of Strategic Sustainability Orientation",slug:"organizational-support-and-sustainable-entrepreneurship-performance-of-smes-the-moderating-role-of-s",signatures:"Muhammad Auwal Abdullahi, Zainalabidin Mohamed, Mad Nasir Shamsudin, Juwaidah Sharifuddin and Fazlin Ali",authors:[{id:"321678",title:"Dr.",name:"Muhammad Auwal",middleName:null,surname:"Abdullahi",fullName:"Muhammad Auwal Abdullahi",slug:"muhammad-auwal-abdullahi"},{id:"328576",title:"Prof.",name:"Zainalabidin",middleName:null,surname:"Mohamed",fullName:"Zainalabidin Mohamed",slug:"zainalabidin-mohamed"},{id:"328577",title:"Prof.",name:"Mad Nasir",middleName:null,surname:"Shamsudin",fullName:"Mad Nasir Shamsudin",slug:"mad-nasir-shamsudin"},{id:"328578",title:"Dr.",name:"Juwaidah",middleName:null,surname:"Sharifuddin",fullName:"Juwaidah Sharifuddin",slug:"juwaidah-sharifuddin"},{id:"328579",title:"Dr.",name:"Fazlin",middleName:null,surname:"Ali",fullName:"Fazlin Ali",slug:"fazlin-ali"}]},{id:"73743",title:"Institutional Structures and Women Sustainability in the Labour Market for Developing Economies",slug:"institutional-structures-and-women-sustainability-in-the-labour-market-for-developing-economies",signatures:"Oluwabunmi O. 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\n
1. Introduction
\n
Total knee arthroplasty is a common surgical procedure for the end stage of knee arthritis, providing long-term pain relief and patient satisfaction. Although many studies have measured the success of knee arthroplasty in terms of survival, another important aspect of TKA is its functional outcome; that is, postoperatively, patients should be free of pain and able to perform daily activities such as standing, walking, and stair-climbing.
\n
The varus knee is the most common deformity that requires total knee arthroplasty. Malalignment affects articular hyaline cartilage, menisci, subchondral bone, and ligaments, and contributes to progression of osteoarthritis (OA). When varus alignment is present, the forces passing the knee are unequally distributed between condyles with an increased load passing through medial condyle due to an increase of the adduction moment during gait [1].
\n
Anatomical changes are present in varus knee as a result of deforming forces. According to Puthumanapully, some reference axes and surface features are significantly different to normal knees [2]. For the femur, he found less femoral anteversion in varus knees. In the tibia, the tubercle (and tibial tubercle axis) was externally rotated and there was a medial tilt of the tibial plateau in the coronal plane. The coronal slope was found to be significantly more (P = 0.001) in varus knees (3.5°) when compared to normal knees (0°), indicating that the slope contributes to the varus deformity. Normal femoral version has been reported to be varied between 10° and 20° [3]. Retroversion or decreasing femoral anteversion is associated with external rotation of the knee and varus deformity contributing to the development of OA in adults [4]. Authors like Bretin and Papaioannou showed that loads shift from center to medial compartment when external femoral malrotation is present [5, 6].
\n
OA also affects the anatomy of superficial medial collateral ligament (MCL), which is the main structure providing medial stability. These changes are secondary to fibrosis of the posteromedial complex, to impingement of marginal osteophytes, and to extrusion of the medial meniscus. According to Haidar, there is no shortening of the MCL in knee OA. There are deforming structures such as the oblique ligament with adhesion and thickening of posteromedial corner structures. Those changes are supposed to cause a posterior bowing to the superficial MCL without an actual shortening of the ligament. The scarring tissue in the posteromedial corner and the adhesion act as a soft phyte tensioning and deform the ligament and the posterior capsule [7].
\n
Ignorance, fear of surgery, access to alternative and traditional medicine, and the high costs of treatment are among main reasons that contribute to late presentation for treatment. Factors like age of the patients, level of activity or disease progression have been discussed when deciding to choose methods of treatment in knee osteoarthritis (OA). Financial aid is a leading factor in decision-making of treating OA. Conservative treatment in knee osteoarthritis is also expensive because it fails to correct the malalignment and abnormal joint loading. The disease will progress and the TKA will be the optimal solution for treatment. Severe preoperative deformities have long been a challenge for surgeons performing total knee arthroplasty.
\n
Limb alignment and proper soft tissue balance are the main factors that influence long-term results of TKA in terms of survivorship. What kind of alignment should be obtained, anatomical, mechanical, or kinematic, is still a matter of debate, but everyone agrees that a balanced prosthetic knee will provide better results. Most of the authors state that the mechanical alignment provides the best chances in terms of survivorship of TKA. Mechanical alignment means that femoral cut is perpendicular to the mechanical axis of the femur and tibial cut is perpendicular to the mechanical axis of the tibia [8].
\n
Technical flows are challenging for surgeons no matter the surgical strategy. A part of this issue is represented by the instruments’ errors. The accuracy of obtaining the desired angle of femoral distal cut is dependent on the ability to actually engage the intramedullary rod in the medullary canal respect the anatomic axis of the femor. This maneuver is influenced by the rod length and diameter and the intramedullary diameter of the femoral canal. The location of the entry hole also could have an impact upon alignment. Do to this, the surgeon must be aware that even if he/she is aiming for a mechanical alignment, for example, the instruments and placement of the entry holes could lead to errors. Alignment is critical to load transfer, both at the articular surface and at the implant-host interface, and hence essential for the success of total knee replacement (TKA). Most of the early failures of TKAs are related to technical flaws. Valgus or varus malpositioning of the tibial component of a total knee implant may cause increased propensity for loosening or implant wear and they may eventually lead to revision surgery [9]. Experimental and clinical data indicate that, in order to achieve optimal mid-term and long-term results of a TKR, good alignment in the frontal plane of the lower limb is mandatory.
\n
Releasing the superficial MCL can sometimes lead to a major instability of the knee and other surgical methods should be assessed for balancing the prosthetic knee in cases of severe varus deformity when aggressive MCL release is expected. A severe varus deformity (more than 15 degrees) is a challenge in terms of the type and extent of release required. More constrained types of implants may be needed if the MCL cannot be trusted.
\n
A balanced knee must be the goal of every TKA because this will increase the chances for a better survivorship [10, 11, 12, 13]. When malalignment is present, some parts of the soft tissue around the knee are contracted and must be released, thus leading to correction of the deformity [14, 15].
\n
When severe varus deformity is present, medial structures become fibrous. Among the methods used to correct severe varus deformity, the most common are subperiosteal release of the superficial medial collateral ligament and joint line release of the medial collateral ligament. Some other methods like medial epicondyle osteotomy (MEO) and tibial reduction osteotomy are less used due to concerns regarding survivorship [16].
\n
For this study, we used the medial epicondyle osteotomy technique because we believe that this method will allow early recovery, bone stock preservation, and a good overall alignment of the limb as we will show later in this chapter. Some authors also used the MEO technique in the past, but their method involves subsequently reattaching the medial epicondyle with screws, sutures, or anchors in an optimal position for balancing the prosthetic knee, which will not allow early rehabilitation after surgery. We did not reattach this fragment and early rehabilitation program was started. The goal of our study was to underline the results of TKA after using MEO as a balancing method for severe varus deformity. The results were compared with those of TKA after using additional resection of the tibial medial plateau to correct this deformity and to those of TKA for varus deformity less than 15 degrees when standard measures were used for balancing.
\n
\n
\n
2. Materials and methods
\n
Between April 2006 and April 2017, we performed 135 TKAs on patients with severe preoperative varus (of more than 15°). The control group included 50 patients with TKA for preoperative varus less than 15°. In 65 cases (40 female and 25 men), the MEO technique was used, and in 70 cases (45 female and 25 men), additional resection of the tibial medial plateau. The mean age at the time of the TKA in MEO group was 68.6; mean height, 1.72 m; and mean weight, 76 kg. In the resection group, the mean age was 65.4 years; mean height, 1.77 m; and mean weight, 76.9 kg. In the control group, there were 30 female and 20 male patients; mean age was 62.5; mean height was 1.71 m; and mean weight was 76 kg.
\n
Patients with preoperative valgus and secondary OA to trauma or inflammatory diseases were not included in the study. All surgeries were performed by the same main surgeon, using the medial-parapatellar and subvastus approaches. The same type of cemented postero-stabilized knee prosthesis was implanted in all cases (Zimmer Nexgen).
\n
No full weight bearing X Ray films were available for this study, so the distal femoral cut was performed at 5° of valgus relative to the anatomical axis of the femur, using an intramedullary rod. The tibial cut was perpendicular to the tibial mechanical axis, also using an intramedullary guide. A 3° femoral external rotation was set in almost every case. Rotation of the femoral component was decided using Whiteside’s line, transepicondylar axis, and posterior condylar reference. A combined anterior and posterior referencing was used for sizing of femur.
\n
All patients underwent stepwise sequential medial soft tissue release consisting of deep MCL, posteromedial release, superficial MCL, and pes anserinus. All the osteophytes were removed. Bony defects were managed with the cement or structural bone grafts and screws. No stem extenders were used. For the control group, no further measures were necessary to balance the prosthetic knee.
\n
For both study groups, these steps were insufficient for balancing the knee and therefore further action was necessary.
\n
In the first group, the surgeon performed a medial epicondyle osteotomy, containing the insertion of the MCL, starting with a saw-blade and finishing with an osteotome (\nFigure 1\n). Then, a valgus stress was applied lowering the epicondyle to its new position. The inferior margin of the epicondyle was cut with a rongeur for not interfering with the articular part of the implant during movements. No fixation method was used for the epicondyle. The flexion and extension gaps were assessed for balance.
\n
Figure 1.
Medial epicondyle osteotomy with TKA.
\n
In the second group, as the medial compartment was still tight in extension and flexion, the surgeon performed a secondary asymmetrical tibial coronal recut using the specific instrument and removed an extra 2 mm of bone from the medial tibial plateau (\nFigure 2\n). Thus proceeding, the extension and flexion gaps were equal and the knee was balanced.
\n
Figure 2.
Additional medial tibial resection (note the varus malposition of tibial component).
\n
For all cases, the patella was resurfaced and no tourniquet was used. Rehabilitation started immediately after surgery, with alternative positioning of the knee in flexion-extension. On day 1 after surgery, all patients started active motion of the operated knee with flexion-extension exercises. Full weight bearing was allowed form day 1, using no brace for protection. No passive motion device was needed. Postoperative follow-up was scheduled 6 weeks, 3 months, 6 months, and 1 year after the surgery, and once per year afterward. The mean follow-up for the study was 7 years (± 3).
\n
The main inclusion criterion for the study group was preoperative varus deformity greater than 15°. The outcomes were measured: Knee Society score (KSS), the range of the motion (ROM), clinical frontal laxity of the knee, femoro-tibial angle, the mean thickness of the polyethylene insert, the amount of resected tibial medial plateau bone, and the union state of the osteotomy site. The amount of resected tibial medial plateau bone was defined as the difference between preoperative and postoperative distance from a perpendicular to the axis of tibia through the peroneal head and a perpendicular to the same axis through the lowermost point of the tibial medial plateau in anteroposterior Rx incidence. The choice of surgical technique was random and we did not use any criteria for performing one or other in this study, but we selected the patients who had a preoperative varus deformity greater than 15°.
\n
Statistical tests were performed using SPSS software. Paired Samples Test was used to compare the results. The 0.05 level was used to denote statistical significance throughout testing.
\n
\n
\n
3. Results
\n
There were no statistically significant differences regarding personal characteristics (age, sex, height, and weight) between the two groups and the control group. No differences were noted regarding postoperative outcomes of KSS, range of motion, femoro-tibial angle, and frontal laxity.
We observed a significant statistical difference regarding positioning of tibial component between groups. The mean angle between tibial component and tibial mechanical axis was 1° ± 3.5°of varus for the MEO group, and 4° ± 2.5° of varus for the resection group (P < 0.001). In the control group, the angle was 0.7° ± 2.3°.
\n
The mean thickness of the polyethylene insert was 12.5 ± 1.24 mm in the MEO group and 13.61 ± 1.59 mm in the second group, with statistically significant P = 0.005.
\n
For all knees with medial epicondyle osteotomy, a fibrous union occurred at the site of osteotomy (\nFigure 3\n). In this group, the amount of resected tibial medial plateau bone (\nFigures 4\n and \n5\n) was statistically significantly smaller than in the other group (1.33 ± 0.46 mm in the MEO group and 3.73 ± 2.5 mm in the other group; P < 0,001).
\n
Figure 3.
Medial epicondyle osteotomy Rx (3 months and 5 years follow up).
\n
Figure 4.
The amount of tibial medial plateau resected bone- MEO.
\n
Figure 5.
The amount of tibial medial plateau resected bone (an additional resection of tibial medial plateau case).
\n
Residual frontal laxity was present in four cases, two in the MEO group and two in the second one. No revision surgery was necessary for any of the cases at the last follow-up.
\n
\n
\n
4. Discussion
\n
The varus knee is the most common deformity that requires total knee arthroplasty. Severe varus deformity grossly affects normal anatomy of the knee, meaning that bone and soft tissue are affected by the disease.
\n
For better survivorship of a knee implant, it is mandatory to achieve a proper alignment and a perfect balance of total knee prosthesis. It is a great challenge for surgeons to balance a severe varus knee due to changes in the anatomy of medial compartment. Fibrosis of the posteromedial complex, marginal osteophytes, extrusion of the medial meniscus, adhesion and thickening of the oblique ligament with all the posterior medial complex, and posterior bowing to the superficial MCL are problems that must be corrected during surgery. MCL release is very important in balancing the fixed varus deformity. The surgeon must progressively release the medial soft tissue until it reaches the length of lateral structures. The endpoint of the release is when the knee is stable and the alignment is optimal. In severe varus deformity, the separation of the periosteal layer from the tibia is distal to the MCL attachment. For this reason, some authors raised concerns about the integrity of the MCL after aggressive release. Releasing the superficial MCL can sometimes lead to a major instability of the knee, requiring a more constrained implant [7]. Our method of medial epicondyle osteotomy for severe varus deformity could prevent this problem.
\n
There are few literature reports that describe MEO as a method of balancing the prosthetic knee. Engh has described his results after medial epicondyle osteotomy during TKA. He performed this procedure on 80 patients [16]. The clinical results showed the KSS improvement from 42 to 93 points after surgery and the range of motion increase from 101 to 111 degrees. He has found no instability in his patients group during the follow-up period. Regarding frontal laxity, the mean varus-valgus stability measured 14.2 points (Knee Society scale, 0–15 points). Improvement of function and patient satisfaction was found in 95% of the cases. In every case of his study, the osteotomized epicondyle was fixed during surgery at the optimal position for balance. Despite this, bone union occurred only in 54% of the knees and fibrous union occurred in 46%. No symptoms like tenderness, restricted motion, or other were associated with fibrous union. Other authors like Sim and Kwak reported their results after using medial epicondylar osteotomy for treating varus deformity in 32 cases [17]. Clinical and radiological outcomes, including the Knee Society score (KSS), the function score (FS), the range of the motion (ROM), the union state of the osteotomy site, were measured. They found an improvement of KSS after surgery from 46.5 ± 7.6 to 89.1 ± 5.9 points (P < 0.001). The FS increased from 39.5 ± 9.2 to 84.2 ± 8.5 points (P < 0.001). Also the range of motion was better after the surgery (101.5° ± 28.2° to 116.0° ± 10.8°; P = 0.006). A significant number of patients presented fibrous union on the osteotomy site despite the fixation of the condyle during procedure (10 patients). Bone union occurred only in 22 knees. There was no significant difference regarding clinical outcomes between the bone union group and the fibrous union group (P = 0.175). The femoro-tibial angle was corrected from an 8.2° ± 5.0°-varus to a 5.6° ± 1.5°-valgus (P < 0.001). Despite the fact that in both studies the epicondyle was fixed with sutures or screws, a major part of the patients presented fibrous union of the epicondyle. The authors concluded that there was no significant difference between the bone union group and the fibrous union group. We do not consider that any reattachment of the epicondyle is necessary, and in consequence, we did not perform fixation in any of the cases. Also no splinting after the surgery was used and the rehab program was started immediately, avoiding knee stiffness and accelerating recovery.
\n
Nobody could tell for sure the ideal positioning of the knee prosthetic components. The disagreement among surgeons is amplified by the significant number of unsatisfied patients with TKA.
\n
Most of the authors state that mechanical alignment provides the best chances in terms of survivorship of TKA. Mechanical alignment means that femoral cut is perpendicular to the mechanical axis of the femur and tibial cut is perpendicular to the mechanical axis of the tibia. If mechanical alignment is achieved, it means that mechanical axis of the leg passes through the center of the knee and the loads are equally distributed between medial and lateral compartments. The native knee interline is inclined about 3 degrees in varus, meaning that the mechanical alignment will change it to 0 degrees, changing the normal anatomy of the knee. The proximal tibial joint line is therefore converted from 87 degrees (3 degrees of varus) to 90 degrees and the distal femoral line from 87 degrees (3 degrees of valgus) to 90 degrees.
\n
For these considerations, some authors proposed the so-called “anatomic alignment” when the tibial component was placed at 3 degrees of varus and the femoral component at 3 degrees of valgus, and overall alignment to be neutral [18]. There is an important variability in natural alignment among population. A significant part of neutral alignment is not normal, leading to distalization of the joint line on the lateral compartment, which can cause anterior knee pain. The concept of restoring constitutional alignment rather than mechanical has gained more interest recently. For the supplementary tibial resection group in our study, we have created the situation of placing the tibial component in varus. In case of a medio-lateral tibial plateau length of 8 cm, an additional resection of 2 mm from medial side lead to a maximum 3 degrees of varus positioning of tibial implant. Attention should be paid in cases where this additional cut adds to a previous unknown error of first cuts due to the instrument’s or surgeon’s mistake, and this could lead to a supplemental varus, and potential danger in terms of survivorship.
\n
Other authors showed that a femoral component placed in 7° valgus, with tibial plateau placed at 90° to the long axis of the tibia, provides equal force distribution between the medial and lateral plateaus and consecutively best chances for survivorship [19]. According to Howell, kinematically aligning the knee means coaligning the transverse axis of the femoral component with the primary transverse axis in the femur about which the tibia flexes and extends and placing the tibial component so that the longitudinal axis of the tibia is perpendicular to the transverse axis in the femur, about which the tibia flexes and extends [20]. This means that the femoral cut is plus 1°–2° in valgus and tibial cut, plus 1°–2° in varus compared with the mechanically aligned total knee arthroplasty [21]. The authors who propose this approach state that restoring mechanical alignment is unnatural in patients with constitutional varus and valgus alignment and could cause higher strain in collateral ligaments [22]. They say that by restoring the native alignment, patients will have better clinical and functional outcome scores as compared with patients in whom the limb alignment is corrected to neutral [23]. The present general consensus is that overall mechanical femoro-tibial alignment should be 0 ± 3 degrees, thus providing the best survivorship chances for the knee implant [24]. No matter of the technique used for TKA, the next important problem for surgeons are technical flows. The accuracy of obtaining the desired angle of femoral distal cut is dependent on the ability to actually engage the intramedullary rod in the medullary canal to be in line with anatomical axis of the femor. This maneuver is influenced by the rod length and diameter and the intramedullary diameter of the femoral canal. The location of the entry hole also could have an impact upon alignment. Do to this, the surgeon must be aware that even if he/she is aiming for a mechanical alignment, for example, the instruments and placement of the entry holes could lead to errors. Regarding tibial component alignment, we observed a significant difference between groups. For the MEO group, the alignment was neutral (1°± 3.5°) and in the resection group, the alignment was mainly in varus (4° ± 2.5°). In 90% of MEO group cases, the tibial component is placed in line with mechanical axis. Only 5% of the knees from the second group present 90° tibial component placement. The vast majority of them are outliers due to additional asymmetric tibial varus cut. The MEO is a method that increases chances for a mechanical alignment of the prosthetic knee.
\n
\n
\n
5. Conclusion
\n
Based on our results, we suggest that the outcomes of TKA with MEO are similar to those with additional resection of the tibial medial plateau and to those from the control group. No revision surgery was needed at the last follow-up in any of the cases.
\n
Some advantages of medial epicondyle osteotomy have resulted from this study. First of all, it avoids excessive weakening of the medial collateral ligament in cases of severe contracture of medial structures by lowering the epicondyle instead of aggressive releasing of the ligament. This will prevent also the need for a more constrained implant. The exposure during surgery is much easier and avoids complications like extensor mechanism disruption. It is a technique that provides optimal conditions for obtaining neutral overall alignment of the limb, minimizing the risk of malpositioning the tibial component, which is higher in cases of additional tibial resection. The tibial bone loss is less than that in additional resection group which is better for revision surgery.
\n
This study highlights early and mid-term results of TKA with medial epicondyle osteotomy. Further analyses are necessary to assess the long-term results of this technique, especially in terms of survivorship. So far, there are no differences between groups regarding patient satisfaction, range of motion, or survivorship.
\n
\n\n',keywords:"medial epicondyle osteotomy, knee varus deformity, total knee arthroplasty, prosthetic outcomes, survivorship",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/70309.pdf",chapterXML:"https://mts.intechopen.com/source/xml/70309.xml",downloadPdfUrl:"/chapter/pdf-download/70309",previewPdfUrl:"/chapter/pdf-preview/70309",totalDownloads:294,totalViews:0,totalCrossrefCites:0,dateSubmitted:"May 2nd 2019",dateReviewed:"September 16th 2019",datePrePublished:"December 2nd 2019",datePublished:"April 22nd 2020",dateFinished:"December 2nd 2019",readingETA:"0",abstract:"Varus malalignment is the most common deformity leading to total knee arthroplasty (TKA) for knee arthritis. For correcting this deformity, a stepwise approach is used by surgeons during TKA. When a severe varus malalignment is present, there are some concerns regarding balancing procedure, meaning that aggressive release of medial structures could lead to instability and need for a more constrained implant. In this chapter, the results of an unconventional method for balancing severe varus malalignment are shown. This method is medial epicondyle osteotomy (MEO). For this reason, a total of 135 knees with severe varus deformity were studied. In 65 cases, the MEO technique was used for balancing during TKA. The other 70 cases were balanced using additional resection of medial tibial plateau. Clinical and radiological outcomes were measured before and after surgery for both groups. Also the results were compared to a control group consisting of 50 patients with TKA for varus deformity less than 15 degrees. The amount of resected tibial bone was noted for study groups. Range of motion, the Knee Society Score (KSS), frontal laxity, and correction of femoro-tibial angle were studied. Frontal laxity decreased from 12.81° ± 3.9° to 0.37° ± 1.2° (P < 0.001). The results showed no statistically significant differences between groups regarding the KSS, range of motion, femoro-tibial angle, and frontal laxity. The amount of resected tibial bone and the mean thickness of the polyethylene insert were statistically significantly smaller in the MEO group. MEO technique could be useful when treating severe varus arthritis knee during TKA by avoiding aggressive medial release and malalignment. Also the bone stock is preserved.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/70309",risUrl:"/chapter/ris/70309",signatures:"Gabriel Stan",book:{id:"9350",title:"Knee Surgery",subtitle:"Reconstruction and Replacement",fullTitle:"Knee Surgery - Reconstruction and Replacement",slug:"knee-surgery-reconstruction-and-replacement",publishedDate:"April 22nd 2020",bookSignature:"João Bosco Sales Nogueira, José Alberto Dias Leite, Leonardo Heráclio Do Carmo Araújo and Marcelo Cortez Bezerra",coverURL:"https://cdn.intechopen.com/books/images_new/9350.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-531-9",printIsbn:"978-1-83880-530-2",pdfIsbn:"978-1-78985-062-8",editors:[{id:"215718",title:"M.Sc.",name:"João Bosco Sales",middleName:null,surname:"Nogueira",slug:"joao-bosco-sales-nogueira",fullName:"João Bosco Sales Nogueira"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"303816",title:"Ph.D.",name:"Gabriel",middleName:null,surname:"Stan",fullName:"Gabriel Stan",slug:"gabriel-stan",email:"gabisus2000@yahoo.com",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Materials and methods",level:"1"},{id:"sec_3",title:"3. Results",level:"1"},{id:"sec_4",title:"4. Discussion",level:"1"},{id:"sec_5",title:"5. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'\nAmis AA. Biomechanics of high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21:197-205. DOI: 10.1007/s00167-012-2122-3\n'},{id:"B2",body:'\nPuthumanapully PK, Harris SJ, Leong A, Cobb JP, Amis AA, Jeffers J. A morphometric study of normal and varus knees. Knee Surgery, Sports Traumatology, Arthroscopy. 2014;22(12):2891-2899. DOI: 10.1007/s00167-014-3337-2\n'},{id:"B3",body:'\nCibulka MT. Determination and significance of femoral neck anteversion. Physical Therapy. 2004;84:550-558\n'},{id:"B4",body:'\nTönnis D, Heinecke A. Diminished femoral antetorsion syndrome: A cause of pain and osteoarthritis. Journal of Pediatric Orthopedics. 1991;11:419-431. DOI: 10.1097/01241398-199107000-00001\n'},{id:"B5",body:'\nBretin P, O’Loughlin PF, Suero EM, Kendoff D, Ostermeier S, Hüfner T, et al. Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures. Archives of Orthopaedic and Trauma Surgery. 2011;131:1115-1120. DOI: 10.1007/s00402-010-1210-4\n'},{id:"B6",body:'\nPapaioannou T, Digas G, Bikos C, Karamoulas V, Magnissalis E. Femoral neck version affects medial femorotibial loading. ISRN Orthopedics. 2013;2013:1-6. DOI: 10.1155/2013/328246\n'},{id:"B7",body:'\nHaidar F, Tarabichi S, Osman A, Elkabbani M, Mohamed T. Understanding the pathological changes of varus knee on MRIcan lead to a better algorithm to balance the knee. Orthopaedic Proceedings. 2019;101-B(SUPP_4):85\n'},{id:"B8",body:'\nInsall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clinical Orthopaedics and Related Research. 1985;192:13\n'},{id:"B9",body:'\nWerner F, Ayers D, Maletsky L. The effect of valgus/varus malalignment on load distribution in total knee replacements. Journal of Biomechanics. 2005;38:349-355\n'},{id:"B10",body:'\nW-Dahl A, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in younger patients. Acta Orthopaedica. 2010;81(2):161-164\n'},{id:"B11",body:'\nPapachristou G, Plessas S, Sourlas J. Deterioration of longterm results following high tibial osteotomy in patients under 60 years of age. International Orthopaedics. 2006;30(5):403-408\n'},{id:"B12",body:'\nEdwards E. The eVect of postoperative collateral ligament laxity in total knee arthroplasty. Clinical Orthopaedics. 1998;236:44\n'},{id:"B13",body:'\nHunt MA, Birmingham TB, Bryant D, et al. Lateral trunk lean explains variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis. Osteoarthritis and Cartilage. 2008;16:591-599\n'},{id:"B14",body:'\nMundermann A, Dyrby CO, Hurwitz DE. Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: Reduced walking speed. Arthritis and Rheumatism. 2004;50:1172-1178\n'},{id:"B15",body:'\nBirmingham TB, Hunt MA, Jones IC. Test–retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis. Arthritis and Rheumatism. 2007;57:1012-1017\n'},{id:"B16",body:'\nEngh GA. Medial epicondylar osteotomy: A technique used with primary and revision total knee arthroplasty to improve surgical exposure and correct varus deformity. Instructional Course Lectures. 1999;48:153-156\n'},{id:"B17",body:'\nSim JA, Kwak JH. Short-term follow-up results of medial epicondylar osteotomy for the varus knee in TKA. Journal of Korean Knee Society. 2009;21:194-204\n'},{id:"B18",body:'\nHungerford DS, Krackow KA. Total joint arthroplasty of the knee. Clinical Orthopaedics and Related Research. 1985;192:23\n'},{id:"B19",body:'\nHsu RW, Himeno S, Coventry MB. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clinical Orthopaedics. 1990;255:215-227\n'},{id:"B20",body:'\nHowell SM, Roth JD, Hull ML. Kinematic alignment in total knee arthroplasty. Definition, history, principle, surgical technique, and results of an alignment option for TKA. Art. 2014;1:44-53\n'},{id:"B21",body:'\nScott W. Kinematic alignment in total knee arthroplasty. In: Insall & Scott Surgery of the Knee. 5th ed. Vol. 121. Churchill Livingstone; 2012. pp. 1255-1268\n'},{id:"B22",body:'\nGu Y, Roth JD, Howell SM, Hull ML. How frequently do four methods for mechanically aligning a total knee arthroplasty cause collateral ligament imbalance and change alignment from normal in white patients? Journal of Bone and Joint Surgery. 2014;96(12):e101\n'},{id:"B23",body:'\nVanlommel L, Vanlommel J, Claes S, Bellemans J. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(10):2325-2330\n'},{id:"B24",body:'\nHD1 C, Math KR, Scuderi GR. Polyethylene post failure in posterior stabilized total knee arthroplasty. The Journal of Arthroplasty. 2004;19(5):652-657\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Gabriel Stan",address:"gabisus2000@yahoo.com",affiliation:'
Carol Davila Faculty of Medicine, Elias University Hospital, Bucharest, Romania
'}],corrections:null},book:{id:"9350",title:"Knee Surgery",subtitle:"Reconstruction and Replacement",fullTitle:"Knee Surgery - Reconstruction and Replacement",slug:"knee-surgery-reconstruction-and-replacement",publishedDate:"April 22nd 2020",bookSignature:"João Bosco Sales Nogueira, José Alberto Dias Leite, Leonardo Heráclio Do Carmo Araújo and Marcelo Cortez Bezerra",coverURL:"https://cdn.intechopen.com/books/images_new/9350.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-531-9",printIsbn:"978-1-83880-530-2",pdfIsbn:"978-1-78985-062-8",editors:[{id:"215718",title:"M.Sc.",name:"João Bosco Sales",middleName:null,surname:"Nogueira",slug:"joao-bosco-sales-nogueira",fullName:"João Bosco Sales Nogueira"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"149247",title:"MSc.",name:"Paloma",middleName:null,surname:"Encinas",email:"paloma.encinas@inia.es",fullName:"Paloma Encinas",slug:"paloma-encinas",position:null,biography:null,institutionString:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"1",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:null},booksEdited:[],chaptersAuthored:[{title:"Use of Microarray Technology to Improve DNA Vaccines in Fish Aquaculture - The Rhabdoviral Model",slug:"use-of-microarray-technology-to-improve-dna-vaccines-in-fish-aquaculture-the-rhabdoviral-model",abstract:null,signatures:"P. Encinas, E. Gomez-Casado, A. Estepa and J.M. Coll",authors:[{id:"74573",title:"Dr.",name:"Julio",surname:"Coll",fullName:"Julio Coll",slug:"julio-coll",email:"juliocoll@inia.es"},{id:"79531",title:"Dr.",name:"Estepa Perez",surname:"Maria Amparo",fullName:"Estepa Perez Maria Amparo",slug:"estepa-perez-maria-amparo",email:"aestepa@umh.es"},{id:"149247",title:"MSc.",name:"Paloma",surname:"Encinas",fullName:"Paloma Encinas",slug:"paloma-encinas",email:"paloma.encinas@inia.es"},{id:"149248",title:"Dr.",name:"Eduardo",surname:"Gomez-Casado",fullName:"Eduardo Gomez-Casado",slug:"eduardo-gomez-casado",email:"casado@inia.es"}],book:{title:"Health and Environment in Aquaculture",slug:"health-and-environment-in-aquaculture",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"74266",title:"Dr.",name:"Miguel",surname:"Betancourt-Lozano",slug:"miguel-betancourt-lozano",fullName:"Miguel Betancourt-Lozano",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"76748",title:"Dr.",name:"Emma",surname:"Fajer-Ávila",slug:"emma-fajer-avila",fullName:"Emma Fajer-Ávila",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Centro de Investigación en Alimentación y Desarrollo",institutionURL:null,country:{name:"Mexico"}}},{id:"78409",title:"Dr.",name:"Hiroshi",surname:"Yokoyama",slug:"hiroshi-yokoyama",fullName:"Hiroshi Yokoyama",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",institutionURL:null,country:{name:"Japan"}}},{id:"79570",title:"Prof.",name:"Jose A.",surname:"Guijarro",slug:"jose-a.-guijarro",fullName:"Jose A. Guijarro",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Oviedo",institutionURL:null,country:{name:"Spain"}}},{id:"79829",title:"Dr",name:"Jose",surname:"Figueras",slug:"jose-figueras",fullName:"Jose Figueras",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"83562",title:"Dr.",name:"Daniel",surname:"Grabner",slug:"daniel-grabner",fullName:"Daniel Grabner",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",institutionURL:null,country:{name:"Japan"}}},{id:"85377",title:"Dr.",name:"Laetitia",surname:"Antonelli",slug:"laetitia-antonelli",fullName:"Laetitia Antonelli",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Corsica Pascal Paoli",institutionURL:null,country:{name:"France"}}},{id:"101505",title:"Dr.",name:"Oscar Basilio",surname:"Del Rio-Zaragoza",slug:"oscar-basilio-del-rio-zaragoza",fullName:"Oscar Basilio Del Rio-Zaragoza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Centro de Investigación en Alimentación y Desarrollo",institutionURL:null,country:{name:"Mexico"}}},{id:"121293",title:"Dr.",name:"Roxana",surname:"Beaz-Hidalgo",slug:"roxana-beaz-hidalgo",fullName:"Roxana Beaz-Hidalgo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"122643",title:"Dr.",name:"Sho",surname:"Shirakashi",slug:"sho-shirakashi",fullName:"Sho Shirakashi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"OA-publishing-fees",title:"Open Access Publishing Fees",intro:"
The Open Access model is applied to all of our publications and is designed to eliminate subscriptions and pay-per-view fees. This approach ensures free, immediate access to full text versions of your research.
As a gold Open Access publisher, an Open Access Publishing Fee is payable on acceptance following peer review of the manuscript. In return, we provide high quality publishing services and exclusive benefits for all contributors. IntechOpen is the trusted publishing partner of over 128,000 international scientists and researchers.
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The Open Access Publishing Fee (OAPF) is payable only after your full chapter, monograph or Compacts monograph is accepted for publication.
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1,400 GBP Chapter - Edited Volume
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10,000 GBP Monograph - Long Form
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4,000 GBP Compacts Monograph - Short Form
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Discoverability - electronic citation and linking via DOI
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Permanent and unrestricted online access to your work
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If a manuscript requires Heavy Editing or Language Polishing, this will incur additional fees.
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To explore funding opportunities and learn more about how you can finance your IntechOpen publication, go to our Open Access Funding page. IntechOpen offers expert assistance to all of its Authors. We can support you in approaching funding bodies and institutions in relation to publishing fees by providing information about compliance with the Open Access policies of your funder or institution. We can also assist with communicating the benefits of Open Access in order to support and strengthen your funding request and provide personal guidance through your application process. You can contact us at oapf@intechopen.com for further details or assistance.
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Choosing to publish with IntechOpen ensures the following benefits:
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Indexing and listing across major repositories, see details ...
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Long-term archiving
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Dissemination and Promotion
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Benefits of Publishing with IntechOpen
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Proven world leader in Open Access book publishing with over 10 years experience
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Fully compliant with OA funding requirements
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Personal support during every step of the publication process
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Currently strongest OA platform with over 150 million downloads
As a gold Open Access publisher, an Open Access Publishing Fee is payable on acceptance following peer review of the manuscript. In return, we provide high quality publishing services and exclusive benefits for all contributors. IntechOpen is the trusted publishing partner of over 128,000 international scientists and researchers.
\n\n
The Open Access Publishing Fee (OAPF) is payable only after your full chapter, monograph or Compacts monograph is accepted for publication.
\n\n
OAPF Publishing Options
\n\n
\n\t
1,400 GBP Chapter - Edited Volume
\n\t
10,000 GBP Monograph - Long Form
\n\t
4,000 GBP Compacts Monograph - Short Form
\n
\n\n
*These prices do not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT as long as provision of the VAT registration number is made during the application process. This is made possible by the EU reverse charge method.
\n\n
Services included are:
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\n\t
An online manuscript tracking system to facilitate your work
\n\t
Personal contact and support throughout the publishing process from your dedicated Author Service Manager
\n\t
Assurance that your manuscript meets the highest publishing standards
\n\t
English language copyediting and proofreading, including the correction of grammatical, spelling, and other common errors
\n\t
XML Typesetting and pagination - web (PDF, HTML) and print files preparation
\n\t
Discoverability - electronic citation and linking via DOI
\n\t
Permanent and unrestricted online access to your work
What isn't covered by the Open Access Publishing Fee?
\n\n
If your manuscript:
\n\n
\n\t
Exceeds 20 pages (for chapters in Edited Volumes), an additional fee of 40 GBP per page will be required
\n\t
If a manuscript requires Heavy Editing or Language Polishing, this will incur additional fees.
\n
\n\n
Your Author Service Manager will inform you of any items not covered by the OAPF and provide exact information regarding those additional costs before proceeding.
\n\n
Open Access Funding
\n\n
To explore funding opportunities and learn more about how you can finance your IntechOpen publication, go to our Open Access Funding page. IntechOpen offers expert assistance to all of its Authors. We can support you in approaching funding bodies and institutions in relation to publishing fees by providing information about compliance with the Open Access policies of your funder or institution. We can also assist with communicating the benefits of Open Access in order to support and strengthen your funding request and provide personal guidance through your application process. You can contact us at oapf@intechopen.com for further details or assistance.
\n\n
For Authors who are still unable to obtain funding from their institutions or research funding bodies for individual projects, IntechOpen does offer the possibility of applying for a Waiver to offset some or all processing feed. Details regarding our Waiver Policy can be found here.
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Added Value of Publishing with IntechOpen
\n\n
Choosing to publish with IntechOpen ensures the following benefits:
\n\n
\n\t
Indexing and listing across major repositories, see details ...
\n\t
Long-term archiving
\n\t
Visibility on the world's strongest OA platform
\n\t
Live Performance Metrics to track readership and the impact of your chapter
\n\t
Dissemination and Promotion
\n
\n\n
Benefits of Publishing with IntechOpen
\n\n
\n\t
Proven world leader in Open Access book publishing with over 10 years experience
\n\t
+5,200 OA books published
\n\t
Most competitive prices in the market
\n\t
Fully compliant with OA funding requirements
\n\t
Optimized processes, enabling publication between 8 and 12 months
\n\t
Personal support during every step of the publication process
\n\t
+146,150 citations in Web of Science databases
\n\t
Currently strongest OA platform with over 150 million downloads
\n
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