Facet joint degeneration as a cause of low back pain.

Recognizing that not all patients with low back pain have lumbar disc disease, the authors began to inject facet joints in June 1982 and have experience now with 21 patients, each injected under fluoroscopic control with a mixture of local anesthetic and steroid. One technical problem occurred when large osteophytes blocked access to the facet joints. Otherwise, there were no complications and minimal morbidity. Most patients (15 of 20; 75%) had an initial response, but a much smaller number (six of 18 followed more than three months; 33%) had a lasting response. Repeat injections, when done, always led to temporary improvement but rarely to lasting relief (one of five; 20%). Three factors characterized the patients: a negative screening examination for other causes of back pain or sciatica; back pain with tenderness localized over one or more facet joints; and radiologic changes of degenerative joint disease within the facet joints. Facet joint disease may be a significant cause of low back pain. The above three criteria are useful in clinical identification of patients with this problem. Facet joint injections play an important role in the diagnosis and treatment of low back pain.

The significance and a comparative analysis of the epidemiology of hip fractures.

A review of the literature on the epidemiology of hip fractures demonstates the predominance of females. Women comprise 70 to 80% of patients with hip fractures. The average age is generally in the eighth decade. Actual incidence rates vary from one study to another, with lower rates among blacks and apparently lower rates from tropical countries. Osteoporosis is more common among patients with hip fractures than in controls and is somewhat more common in intertrochanteric fractures than in femoral neck fractures. Most hip fractures result from comparatively minor falls, such as falls from a bed, a chair, or from a standing position, especially among the elderly. It is estimated that more than 200,000 hip fractures occur each year in the United States, and that the cost of caring for these patients is more than $750,000,000. Approximately 19% of these patients die as a result of the fracture. This contributes significantly to the total number of accidental deaths, which in turn is the fourth largest category in the list of causes of death in the United States.

A new method of patellectomy for patellofemoral arthritis.

Total patellectomy, although it has a biomechanical disadvantage in that it may lead to a degree of quadriceps weakness, is frequently indicated in selected patients. Numerous different techniques of performing patellectomy have been described. In this paper, we present a technique of performing a patellectomy in which the continuity of the quadriceps mechanism is not disrupted and the vastuc medialis is advanced. Twenty-six patients (twenty-nine knees) in whom the procedure was performed were studied retrospectively. The findings in this series showed 90 per cent good or excellent results, two cases of extensor lag, an average of 118 degrees of knee flexion, minimum quadriceps atrophy with good strength, and minimum postoperative immobilization. The method presented has the important advantage of an easier, smoother postoperative knee-rehabilitation period, which is extremely advantageous in elderly patients.

A calcified fibrocartilagenous nodule in the ligamentum nuchae. Presenting as a tumor.

Nodules of fibrocartilage, calcified fibrocartilage, or bone may be found in the adult ligamentum nuchae. These are generally asymptomatic but may mimic fractures or, as in the case presented here, tumors.

Dislocations after total hip-replacement arthroplasties.

In a series of 300 total hip replacements, nine (3 per cent) dislocated. Precise measurements of the orientation of the acetabular cup were made and it was found that anterior dislocations were associated with increased acetabular-component anteversion. There was no significant correlation between cup-orientation angle and posterior dislocation. The dislocation rate for cup orientation with anteversion of 15 +/- 10 degrees and lateral opening of 40 +/- 10 degrees was 1.5 per cent, while outside this "safe" range the dislocation rate was 6.1 per cent. Other factors that were documented include time after surgery (with the greatest risk in the first thirty days) and surgical history (with a greater risk in hips that have had prior surgery).