Treatment of lumbosacral radicular pain with epidural steroid injections.

Fifty patients with an average age of 47 years received epidural steroid injections for lumbosacral radicular pain due to disk herniation or spinal stenosis. All patients had failed previous conservative treatment. Mean follow-up was 24 months (range: 12-36 months). Immediately after injection, all 50 patients reported various degrees of relief from leg and back pain. At the last follow-up examination, 68% of patients were asymptomatic, 20% had no change in preinjection radicular symptoms, and 12% had various degrees of relief. No significant correlation was found between pain relief, age, or number of injections. Early pain relief may be anticipated after epidural steroid injections in 80% of patients with radicular symptoms due to disk herniation or spinal stenosis.

Long-term mechanical stability of the impacted morselized graft-cement interface in total joint replacement: an experimental study in dogs.

This experimental study compared the long-term (12 months) mechanical stability of the morselized graft-cement interface with the conventional bone-cement interface in both femoral bones of 10 adult dogs. For mechanical testing, three-point bending and push-out loading tests of composite bone-cement beams were used, while the incorporation of the graft was assessed by serial radiographs. Although the parameters fracture load and interface failure load showed inferior values in the specimens with a morselized graft-cement interface compared to those in specimens with a conventional bone-cement interface, no statistically significant differences were found between groups. Radiographic reconstitution of the lateral femoral cortex was observed in all animals at 3 months while signs of advanced remodeling were apparent at 6 months. These results indicate the long-term mechanical stability of the impacted morselized graft-cement interface is comparable to that of the conventional bone-cement interface created in primary total hip replacements provided the grafted area is protected from early heavy loading.

Epidemiology, demographics, and natural history of congenital hip disease in adults.

This study examined the epidemiology and demographics of congenital hip disease in 468 (660 hips) patients who were examined between 1970 and 1996. In 356 (54%) hips, the diagnosis was secondary osteoarthritis due to congenital hip disease, and in 272 (41%) hips, the diagnosis was idiopathic osteoarthritis. In the remaining 32 (5%) hips, the diagnosis was uncertain. Of the hips with congenital hip disease, 170 (47.7%) hips were dysplastic, 85 (23.9%) had low dislocation, and 101 (28.4%) high dislocation. The majority of patients with congenital hip disease were women (338 [95%] hips). The natural history of the three types of congenital hip disease was studied in 157 patients (202 hips: 102 dysplastic, 42 low dislocation, and 58 high dislocation) who had received no treatment before the initial examination. Average length of follow-up was 17 years. In dysplastic hips, the disease remained undiagnosed until the onset of symptoms at an average age of 34.5 years. In patients with low dislocation, pain had started at an average of 32.5 years due to progressive degenerative arthritis within the false acetabulum. In patients with high dislocation, in the presence of a false acetabulum, pain started at an average age of 31.2 years, while in its absence, pain started at an average age of 46.4 years due to muscle fatigue. These findings suggest dysplasia, low dislocation, and high dislocation in adults are the results of untreated dysplasia, subluxation, and complete dislocation in infancy, respectively.