[Rehabilitation outcomes following knee arthroplasty: a retrospective study of 90 patients]. / Suites opératoires en rééducation après arthroplastie du genou: étude rétrospective à propos de 90 patients.

The objective of rehabilitation after arthroplasty is the restoration of satisfactory joint amplitude and muscular strength. The objective of this study was to determine the reasons for hospitalization for rehabilitation after knee arthroplasty, duration of stay and perioperative morbidity. The retrospective and descriptive study included 90 patients. The average age of patients was 74.5 years. A total of 84% of patients underwent primary arthroplasty and 16% secondary arthroplasty, with 7% undergoing bilateral arthroplasty. Of the patients, 88% displayed a comorbidity; 16% a deficit in flexion or extension. A total of 28% were dependents and 43% lived alone at home. Local adverse events occurred in 48% of the patients and general adverse events in 59%; deep venous thrombosis and/or pulmonary embolism were the most frequently described events (15.5%). The duration of stay for rehabilitation was 8.8 days in surgery, and 19.9 days in a rehabilitation center. The mean duration of stay was the greatest for patients with bilateral arthroplasty, those with a serious complications and older patients. The factors that determine hospitalization for rehabilitation after knee arthroplasty include older age, with comorbidity held constant; bilateral or secondary arthroplasty; level of disability; degree of dependence; living alone at home; and complications. A short stay in surgery followed by a short stay in rehabilitation center is possible with a network management.

Back pain and spinal alignment abnormalities in schoolchildren.

OBJECTIVES: To study the prevalence of back pain and spinal alignment abnormalities in children aged 10 to 14 years; to define subsets of subjects with similar clinical profiles; and to identify factors associated with pain in the thoracic or lumbar spine. PATIENTS AND METHODS: 972 five- and nine-graders completed a back pain questionnaire at school and were examined by a school physician for spinal alignment abnormalities and for motion range limitation in the spine and/or lower limbs. Multivariate analysis was used to define clinical subsets and to identify factors associated with back pain. RESULTS: The point prevalence of back pain increased with age, from 14.3% in the ten-year-olds to 24% in the 14-year-olds. Girls were more likely than boys to report back pain, which was usually located in the low back. The prevalence of scoliosis increased with age and was higher in the girls. Multivariate analysis identified five clinical profiles: no spinal pain; nonserious spinal pain with no impact on medical service utilization or physical activities; spinal pain unrelated to an injury; injury-related spinal pain not treated by drugs or physical therapy; and injury-related spinal pain treated by drugs and physical therapy. Several factors associated with spinal pain were identified, with variations across the five groups.

Non-specific low back pain in children and adolescents: risk factors.

Low back pain (LBP) among children and adolescents has become the subject of an increasing amount of literature over the last 15 years. This topic, which was considered almost insignificant less than two decades ago, was the focus of a recent international meeting organised in Grenoble (France) in March 1999. This review paper is the result of an literature update search performed by members of three groups which have been active in this field for many years. Current epidemiological data on LBP is summarized as well as the role of the major risk factors according to studies published in the principal peer reviewed journals interested in the topic.

Femoral neuralgia due to degenerative spinal disease. A retrospective clinical and radio-anatomical study of one hundred cases.

We report a study of 100 patients admitted to the Grenoble Regional Teaching Hospital between July 1985 and February 1994 for femoral neuralgia due to degenerative spinal disease. A herniated disk resulting in nerve root impingement was found in 79 patients (83 herniated disks) and lumbar spinal stenosis in 21. The level of nerve root compromise was L2-L3 in eight cases, L3-L4 in 35 cases, and L4-L5 in 40 cases. Herniated disks were divided into several groups based on their location with regard to the intervertebral foramen: posterolateral herniations were entirely contained within the spinal canal (n = 12; 14.5%), whereas far lateral, or foraminal, herniations (n = 71; 85.5%) involved the intervertebral foramen. Twenty-nine foraminal herniations (34.9%) had a component located within the spinal canal (medioforaminal herniations), 33 (39.8%) were entirely contained within the foramen (pure foraminal herniations), and nine (10.8%) were located lateral to the foramen (lateroforaminal herniations). As compared with posterolateral herniations, foraminal herniations were associated with shorter symptom duration at admission (p < 0.05), a greater likelihood of nocturnal exacerbation of pain (p < 0.001) and of a positive femoral stretch test (p < 0.01), and failure of the pain to worsen during Valsalva maneuvers (p < 0.01).

Percutaneous intradiscal radio-frequency thermocoagulation. A cadaveric study.

STUDY DESIGN: This study examined the effect of radio-frequency thermocoagulation on cadaveric disc material. Radio-frequency lesions are induced to decompress the nerve root by coagulating the nucleus pulposus. OBJECTIVES: The purpose of this study was to assess the potential of the radio-frequency lesion technique for treating lumbar disc herniation percutaneously. The effect of radio-frequency thermocoagulation on cadaveric disc material was studied. SUMMARY OF BACKGROUND DATA: An intradiscal bipolar electrode is used for the thermocoagulation of the nucleus pulposus. METHODS: Lumbar discs of 27 adult cadavers were used for the experiments within 72 hours of donors' deaths. The physical and thermal parameters of intradiscal radio-frequency thermocoagulation were determined experimentally. Acute macroscopic and histologic changes before and after thermocoagulation were investigated. The temperature distribution of the tissue surrounding the disc was measured during the operation using thermocouples to evaluate potential heat damage. Also, computed tomography and magnetic resonance imaging of the disc were performed before and after thermocoagulation. RESULTS: Macroscopic observation showed that the lesion induced by radio-frequency thermocoagulation is homogeneous and intense without necrosis, and is limited to the nucleus pulposus. Histologically, the endplates and vertebral bodies were unaffected and an architectural disorganization of the stroma of the nucleus pulposus was seen. The temperature increase of the tissue surrounding the discs did not exceed 3-4 C. CONCLUSION: A bipolar electrode and a radio-frequency alternating current permits percutaneous intradiscal thermocoagulation for destruction of a portion of disc material in a cadaveric spine.

Back pain in school children. A study among 1178 pupils.

The purpose of this study was to determine the prevalence of back pain in school children and the role of several contributing factors; 1178 school children of both sexes answered a previously validated questionnaire. The cumulative prevalence of back pain was 51.2%. Lumbar and leg pain, and thoracic pain were more common. After multivariate analysis, five qualitative variables were correlated with back pain with a statistical, significant positive correlation with age, previous back injury, volley-ball, female sex and time spent watching television.

[Socioeconomic incidences and prognostic factors of low back pain caused by occupational injuries among the hospital personnel of Grenoble University Hospital Center]. / Incidences socio-économiques et facteurs pronostiques des lombalgies par accident du travail dans le personnel hospitalier du CHU de Grenoble.

Low back pain is generally believed to be common among hospital employees. This cross-sectional, retrospective study was carried out to determine the annual incidence of low back pain ascribable to occupational injuries in hospital employees and to evaluate factors influencing the prognosis of these injuries. In 1989, 70 employees working at the Grenoble Teaching Hospital (GTH) reported an occupational injury responsible for low back pain. Each of these employees filled out an epidemiological questionnaire during a routine evaluation by a rheumatologist. Overall annual incidence of occupational injuries with subsequent low back pain was 1.9% among GTH employees. Higher incidences were seen among employees whose occupations involved patient transfer, as well as among nursing assistants. Activities associated with an increased risk of low back pain included handling of patients or objects and work requiring prolonged periods in uncomfortable positions or in the standing position. A previous history of low back disease and a longer period of time in the current work were also associated with an increased risk of low back pain. Characteristic clinical profiles of patients with low back pain subsequent to occupational injury were determined by occupation and type of hospital department. The analysis of long-duration absence from work and long-term consequences on career confirmed the significant adverse socioeconomic impact of these injuries.

Skeletal involvement as the initial disease manifestation in Hodgkin's disease: a review of 6 cases.

Initial signs of malignant lymphoma are rarely due to bone lesions. We reviewed 6 cases with early skeletal involvement, recently observed in the rheumatology and hematology departments. In 3 patients, magnetic resonance imaging (MRI) was added to traditional investigations, including radiography, radionuclide bone scan and computerized tomography. We stress the possibility of bone involvement in the clinical onset of malignant lymphoma and the usefulness of early bone assessment using MRI.

[Bone manifestations disclosing Hodgkin's disease and non-Hodgkin's malignant lymphoma. Analysis of 11 cases]. / Manifestations osseuses révélatrices de maladies de Hodgkin et de lymphomes malins non hodgkiniens. Analyse de onze observations.

Bone localizations revealing Hodgkin's disease or non-Hodgkin's malignant lymphoma, are unusual. We are reporting 11 recent cases collected in rheumatology and haematology departments, including 4 where a comprehensive study of X-rays, scintigrams, axial tomograms and nuclear magnetic resonance imaging was performed. Review of the literature as well as our experience concerning the type of onset of the bone involvement, the clinical correlation, the imaging techniques, have led us to consider nuclear magnetic resonance as a decisive factor which should be offered at an early stage in the diagnostic approach.