ABSTRACT
BACKGROUND: The direct anterior approach for THA allows implantation through an internervous plane without muscle detachment from bone. However, the classic longitudinal skin incision does not follow the anatomic skin creases and can result in scar widening. We therefore modified our incision technique to a short oblique skin incision following the anatomic skin crease of the groin. QUESTIONS/PURPOSES: We sought to determine whether (1) the oblique incision leads to improved scar results compared with the longitudinal incision, (2) functional and pain scores are similar between the two approaches, and (3) the new incision is safe with respect to complications, blood loss, implant position, and lateral femoral cutaneous nerve (LFCN) symptoms. METHODS: Fifty-nine patients underwent THAs using either the classic (n = 33) or the new oblique incision (n = 26). At 6 months after surgery, we compared objective and subjective scar results, WOMAC, Oxford Hip and UCLA scores, blood loss, cup inclination, and the presence of LFCN symptoms between both groups. RESULTS: Objectively, the modified incision resulted in significantly shorter and narrower scars. Subjectively, patients in the modified incision group were substantially more satisfied with the aesthetic appearance. Functional and pain scores were similar. No complications occurred in either group. Blood loss and cup inclination did not differ between the two groups. There were no differences in LFCN symptoms. CONCLUSIONS: In this series, which selected for thinner patients in the study group, the 'bikini' incision for an anterior approach THA led to improved scar cosmesis and was found to be safe in terms of blood loss, appropriate component placement, and risk for LFCN injury. LEVEL OF EVIDENCE: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Hip Joint/surgery , Biomechanical Phenomena , Blood Loss, Surgical , Cicatrix/etiology , Female , Femoral Nerve/injuries , Groin , Hip Joint/physiopathology , Humans , Male , Minimally Invasive Surgical Procedures , Pain, Postoperative/etiology , Patient Satisfaction , Peripheral Nerve Injuries/etiology , Postoperative Hemorrhage/etiology , Recovery of Function , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Animal experiments indicate that 1,1,1-trichloroethane can cause degeneration of the olfactory epithelium. The effects of 1,1,1-trichloroethane on human odor perception still have not been investigated. The goal of this study was to learn more about acute effects of 1,1,1-trichloroethane. METHODS: Twelve healthy, nonsmoking students were exposed to 200 and 20 ppm (control) 1,1,1-trichloroethane in an exposure chamber for 4 hours according to a crossover design. Olfactory functioning was investigated with the Sniffin' Sticks. The test includes the determination of the detection threshold for n-butanol and an odor identification test. RESULTS: After 1 hour of exposure to 200 ppm 1,1,1-trichloroethane, no effects on olfactory functioning were observed. After 4 hours, the olfactory threshold for n-butanol was slightly (p = 0.04) elevated. CONCLUSION: The threshold shift may be caused by different mechanisms, including inflammation of the olfactory mucosa or degeneration of receptor cells.
Subject(s)
Olfaction Disorders/chemically induced , Olfactory Nerve/drug effects , Trichloroethanes/pharmacology , Administration, Inhalation , Adult , Case-Control Studies , Cross-Over Studies , Dose-Response Relationship, Drug , Humans , Male , Olfactory Mucosa/drug effects , Perception , Probability , Sensitivity and Specificity , Sensory Thresholds , Statistics, NonparametricABSTRACT
This study was designed to investigate subclinical irritating effects of methanol on functional and immunologic parameters in human respiratory epithelia. Twelve healthy, nonsmoking individuals were exposed to concentrations of 20 and 200 ppm of methanol in an exposure chamber. The concentrations of interleukin (IL)-8, IL-1beta, IL-6, and prostaglandin E2 (PGE2) were monitored. The saccharin transport time test was used to evaluate mucociliary transport. Video interference contrast microscopy was used to determine the ciliary beat frequency of nasal epithelial cells. Subjective symptoms were assessed with a questionnaire. The median concentrations of IL-8 and IL-1beta were significantly elevated after exposure to 200 ppm of methanol as compared to exposure to 20 ppm (IL-1beta, 21.4 versus 8.3 pg/mL, p = .001; IL-8, 424 versus 356 pg/mL, p = .02). The release of IL-6 and PGE2 did not change significantly (IL-6, 10.3 versus 6.5 pg/mL, p = .13; PGE2, 13.6 versus 13.4 pg/mL), nor did the ciliary beat frequency or the saccharin transport time. Both IL-8 and IL-1beta proved to be sensitive indicators for subclinical irritating effects of methanol in vivo. The German threshold limit of 200 ppm of methanol does not prevent subclinical inflammatory reactions of the nasal respiratory mucosa.
