A posterior approach to the hip joint with complete posterior capsular and muscular repair.

A posterior approach to the hip is described, which preserves the posterior hip capsule and short external rotators. These structures are reflected during exposure and are securely repaired to bone as a single capsulomuscular flap during wound closure. This approach has been used exclusively since December 1986 for uncomplicated primary hip arthroplasty. In 259 consecutive cases, there have been only two dislocations, both associated with significant trauma.

Indium-111 leukocyte scanning and fracture healing.

This study was undertaken to determine the specificity of indium-111 leukocyte scans for osteomyelitis when fractures are present. Midshaft tibial osteotomies were performed in 14 New Zealand white rabbits, seven of which were infected postoperatively with Staphylococcus aureus per Norden's protocol. All 14 rabbits were scanned following injection with 75 microCi of indium 111 at 72 h after osteotomy and at weekly intervals for 4 weeks. Before the rabbits were killed, the fracture sites were cultured to document the presence or absence of infection. The results of all infected osteotomy sites were positive, whereas no positive scans were found in the noninfected osteotomies. We concluded from this study that uncomplicated fracture healing does not result in a positive indium-111 leukocyte scan.

The prevention of heterotopic bone formation following total hip arthroplasty using 600 rad in a single dose.

While postoperative irradiation has been shown to lower the incidence of heterotopic ossification effectively in high-risk patients following total hip arthroplasty, patients in multiple-dose protocols continue to develop some heterotopic ossification despite therapy. Sixteen patients (17 hips) received single-dose exposure to 600 rad delivered within 3 days of total hip arthroplasty. The patients were considered at high risk for development of heterotopic ossification because of hypertrophic osteoarthritis, posttraumatic arthritis, or the presence of previously formed ectopic bone. Thirty-five percent of the patients underwent excision of preexisting ectopic bone at the time of arthroplasty. The average follow-up period was 11.8 months (range, 6-24 months). At follow-up study, all hips were classified as Brooker class O or I, compared to a 17% incidence of Brooker class II and III for previously reported multiple-dose protocols. All patients were asymptomatic at last follow-up study, and no component demonstrated subsidence or radiolucent lines indicative of loosening. The authors conclude that low-dose, single-fraction radiotherapy is more cost-effective and convenient and as efficacious as current multiple-dose regimens.