Joint arthroplasty procedures are significant in number and cost. Discharging hip and knee arthroplasty patients early from the hospital to a transitional home care program has the potential to reduce costs, while maintaining quality. A retrospective review of hospital records of hip and knee arthroplasty patients quantified patient problems during postoperative days 3 through 12 and analyzed them by age, gender, and joint type. The pilot study also allowed the development of a protocol for transitional home care after hip and knee arthroplasty.

Adult↗

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Occipitoatlantal hypermobility.

Explore the source record for details and available documents.

Adolescent↗

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Low-back pain and sciatica following total hip replacement: a report of two cases.

Two cases of low-back pain and sciatica following total hip replacement are reported. Both patients were operated upon and after lumbar decompression were free of pain. A theory is presented to suggest that the lengthening of the limb after total hip replacement puts excess tension on the spinal nerves and, in conjunction with preexisting degenerative disc disease, will precipitate low-back pain and sciatica.

Aged↗

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Acute low-back pain. An objective analysis of conservative therapy.

The roles of bedrest, antiinflammatory medication, and analgesic medication in the treatment of acute back strain were objectively analyzed to determine whether they have a measurable effect on the return of patients to full daily activities as well as on the relief of pain. Two hundred patients were studied prospectively. Each patient had the diagnosis of acute back strain, which was defined as nonradiating low-back pain. The results of the patient's neurologic examination, straight leg raising test, and lumbosacral spine roentgenograms had to be within normal limits for the patient to be included in the study. The results showed that bedrest, as compared with ambulation, will decrease the amount of time lost from work by 50%. Bedrest will also decrease the amount of discomfort by 60%. Analgesic medication, when combined with bedrest, will further decrease the amount of pain incurred, particularly when used in the first three days of the healing process. However, analgesic medication will not allow a more prompt return to work. Antiinflammatory medication, when added to bedrest in the treatment of lumbago, does not provide an advantage over bedrest alone.

Adolescent↗

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The conservative treatment of sciatica.

The mainstay of rational treatment of acute sciatica involves bed rest and antiinflammatory drugs. The authors recommended 2 weeks of complete bed rest with progressive gradual mobilization over the next 7-10 days. Buffered aspirin in a dosage of 10-15 grains every 4 hours is prescribed both for its analgesic effect as well as for its antiinflammatory properties. Through the low-back school, the patient is instructed in low-back hygiene. Physically capable patients are encouraged to begin an aerobic exercise program. In the absence of absolute indications for surgery (cauda equina syndrome or marked progressive muscle weakness) it seems reasonable to permit up to 3 months of conservative therapy before recommending surgery.

Adult↗

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Subacute instability of the cervical spine.

The purpose of this article is to describe a new entity, subacute instability of the cervical spine. It is defined as the development of radiographic evidence of cervical instability within 3 weeks of a cervical spine injury when initial adequate roentgenograms show no bony or soft tissue abnormality. Six patients who conform to this definition are reported. Each was found to have developed neurologic deficit and radiographic evidence of instability of the cervical spine on repeat examination when none was present initially. There were four unilateral facet dislocations (two C5-C6, one C6-C7, one C4-C5), one perched facet (C5-C6), and one extension subluxation (C4-C5). The mechanism of subacute instability is thought to be due to the elastic and plastic deformation of the ligamentous structures and discs of the cervical spine. An algorithm has been developed and is described for evaluation of patients with cervical trauma and initial normal radiographs. By alerting physicians to the entity of subacute instability of the cervical spine, it is hoped that injuries of this nature will be discovered so that appropriate treatment can be rendered before a fixed deformity develops.

Adult↗

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The Pennsylvania Plan. An algorithm for the management of lumbar degenerative disc disease.

An algorithm for the sequential management of the patient with low-back pain has been formulated from evaluation of treatment outcomes. Patients presenting with back pain complaints and cauda equina syndrome are evaluated with immediate myelography. Without this complication, back pain patients are treated with 6 weeks of conservative therapy. Those who fail to respond are evaluated with progressively more complex techniques. When sciatica predominates, treatment may ultimately include laminectomy. When back pain predominates, medical and psychosocial appraisal are recommended. Some with normal medical and psychosocial evaluations may become candidates for spine fusion. The remaining are treated according to the findings of such appraisals. Rigorous screening is mandatory prior to any surgery.

Algorithms↗