Volume 110, Issue 1

Context: The two-incision approach to total hip arthroplasty (THA) has received increasing attention in recent years. However, the benefits of this procedure have been debated. Objectives: To evaluate the two-incision THA technique compared to the standard anterolateral THA approach in a community hospital setting. Methods: A retrospective review of records from patients who had THA at Memorial Hospital of York in Pennsylvania. Outcomes for patients who received the two-incision THA technique were compared to those who had a standard anterolateral THA approach. Perioperative parameters included operation duration and complication rates. Early function was evaluated by hospital length of stay and whether patients were discharged home or to a rehabilitation center. Results: Twenty-eight patients had 30 THAs with a two-incision technique, and 30 patients had a standard anterolateral THA. Demographic parameters were similar among both groups. The two-incision THA group had a longer mean operation time by 34 minutes but shorter hospital stay by 0.8 days. Patients in the two-incision THA group were discharged to home 87% of the time compared to 43% in the anterolateral group. In addition, 4 patients (13%) in the two-incision group had an orthopedic complication compared to no complications in the anterolateral group. Conclusion: There were longer operative times, shorter hospital stays, and higher complication rates among patients who received the two-incision THA. Patients who receive the two-incision THA should be selected carefully and advised about the potential for increased complications.

Dapsone is a leprostatic agent commonly prescribed for the treatment of patients with leprosy, malaria, and a variety of blistering skin diseases, including dermatitis herpetiformis. Methemoglobinemia, a potentially life-threatening condition in which the oxygen-carrying capacity of blood in body tissues is reduced, is a known adverse effect of dapsone use. The authors report a case of dapsone-induced methemoglobinemia observed in the emergency department during routine workup for contact dermatitis in a patient with celiac disease. The pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia are discussed.

Relatively few cases of trisomy 8 mosaicism syndrome (T8mS) are documented in the medical literature. It is a rare genetic condition characterized by extreme phenotypic variability—ranging from severe congenital malformations to minute dysmorphic changes. The authors describe a case of T8mS in a man aged 33 years who presented with lumbar spine herniated nucleus propulsus. This case features some of the classic characteristics of T8mS and suggests an association between T8mS and herniated disks.