Prevention of joint dislocation after total hip arthroplasty (THA) is important to keep suitable relationships between surgeons and patients. Capsule has an essential role for stability of joint, especially in hip. Reserving a part of capsule in THA can increase stability. We examined the effect of partial capsulotomy in hip joint for prevention of dislocations after THA.

In 178 primary THA for osteoarthritis, partial capsulotomy were performed in 92 cases and generous capsulectomy in 86 cases from 1993 to 2001. Age, gender, pre-operative complications of both groups were matched. All THA were performed from a posterior approach, and in case of partial capsulotomy, anterior one third of hip joint capsule was reserved before placing acetabular component. Posterior capsulorrhaphy was not performed.

No hip dislocations have been seen in partial capsulotomy cases, and four posterior dislocations following THA were observed in general capsulectomy cases during one to nine year follow up.

Soft tissue imbalance of THA is most at risk for dislocation. The present study showed a satisfying result of partial capsulotomy for prevention of THA dislocation. Residual hip joint capsule can increase joint stability and can resist to dislocation after THA in osteoarthritis.

Purpose: There are a wide variety of operative procedures for lumbar spinal canal stenosis. Bilateral fenestration, preserving the continuity of the lamina and spinous processes, has widely been employed in our department and its affiliated hospitals. The following questions are raised: Are decompressive effects of fenestration and spinal stability maintained without spinal fusion or instrumentation? In order to answer the questions, we compared the rates of revision after fenestration with those after laminectomy alone and decompressive surgery with spinal fusion.

Materials and methods: The registry of spinal surgeries of our university and affiliated hospitals from 1988 to 1997 was consulted.

During the first 5-years period 1159 patients underwent decompressive surgery. 908 of them had spondylosis and 251 had degenerative spondylolisthesis (DO) as a contributing factors of neural compression. Fenestration was done in 740 (81%) of patients with spondylosis and in 176 (70%) of patients with DO.

Results: Regarding the whole series 31 out of 1159 patients had a revision. The revision rate was 2.7%. 15 out of 908 patients (1.7%) with spondylosis and 16 out of 251 patients (6.4%) with DO underwent revisions. 11 out of 740 (1.5%) with spondylosis and 11 out of 176 (6.3%) with DO underwent revisions after fenestration. No significant differences were found among the revision rate of fenestration, laminectomy and decompressive surgery with spinal fusion.

Conclusion: The decompressive effect of fenestration was maintained long enough, even for degenerative spondylolisthesis. As a first operation spinal fusion is not necessarily indicated for lumbar canal stenosis.

Diagnostic indices for the determination of involved nerve root in cervical radiculopathy have been described by Yoss (1957), Murphey (1973) and Hoppenfeld (1976). However, there has been criticism that their indices are inappropriate for the diagnosis, because involved nerve root can not necessarily be determined using them. Difficulties in diagnosis have been attributed to the variable patterns of symptoms and signs caused by nerve root compression.

Purpose: To develop the new diagnostic indices for determination of involved nerve root in cervical radiculopathy.

Methods: Forty-five cases operated on through posterior foraminotomy were reviewed. The sites of neck pain(s) (in nape, in suprascapular, superior angle of scapula, interscapular, or scapular regions), and arm pain (anterior, lateral, posterior or medial) in anatomical position were preoperatively recorded. The finger(s) with subjective paraesthesia or objective sensory change, and the finger(s) of the most severe involvement were recorded. Affected muscle(s) (deltoid, biceps, wrist extensor, wrist flexor, triceps, finger extensor, or intrinsic), and the muscle(s) of the weakest were recorded. All of 45 cases were decompressed unilaterally at only 1 level, and showed improvements just after operation. Involved nerve roots and number of their cases were as follows: C5, 7; C6, 12; C7, 13; C8, 13.

Results: Pain in the suprascapular region frequently (82%) indicated C5 or C6 radiculopathy. Interscapular or scapular pain always (100%) indicated C7 or C8 radiculopathy. Lateral, posterior, or medial arm pain frequently indicated C6, C7 or C8 radiculopathy, respectively. Involved nerve roots and number of patterns of finger paraesthesia [or sensory change] were as follows: C5, 0 [0]; C6, 4 [5]; C7, 8 [10]; C8, 4 [5]. However, when the most severe involvement was that of the thumb, the index or long finger, or the little finger, the indication was C6, C7 or C8 radiculopathy, respectively. Although patterns in affection of muscles were also variable, when the weakest muscle was deltoid, biceps or wrist extensor, wrist flexor or triceps, or intrinsic, the indication was C5, C6, C7 or C8 radiculopathy, respectively.

Conclusion: The sites of the neck and arm pain are important for the diagnosis of the involved nerve root. Not the fingers with paraesthesia but the fingers with the most severe involvement lead to the diagnosis.

We performed dynamic MRI of the femoral head within 48 hours of injury on 22 patients with subcapital fracture of the neck of the femur and on a control group of 20 of whom ten were healthy subjects and ten were patients with an intertrochanteric fracture. Three MRI patterns emerged when the results between the fractured side and the contralateral femoral head were compared. In all of the control group and in those patients who had undisplaced fractures (Garden stages I and II), perfusion of the femoral head was considered to be at the same level as on the unaffected side. In patients with displaced fractures (Garden stages III and IV) almost all the femoral heads on the fractured side were impaired or totally avascular, although some had the same level of perfusion as the unaffected side. We conclude that dynamic MRI, a new non-invasive imaging technique, is useful for evaluating the perfusion of the femoral head.

We measured the isokinetic strength of abduction, adduction, internal rotation, and external rotation in ten patients with full-thickness tears of the supraspinatus and ten with partial-thickness tears. The measurements were repeated after intra-articular or intrabursal injection of local anaesthetic.

Pain blocks produced significant increases in strength in both full and partial-thickness tears. After the block, the strength in full-thickness tears compared with the opposite side was 67% to 81% in abduction and 67% to 78% in external rotation, both significantly smaller than those on the uninvolved side (p = 0.0064, p = 0.0170). In partial-thickness tears the strength after the block ranged from 82% to 111%, with no significant differences between the involved and uninvolved sides.

The decreases in strength of 19% to 33% in abduction and 22% to 33% in external rotation after full-thickness tears appear to represent the contribution of supraspinatus to the strength of the shoulder.