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Knee Surgery, Sports Traumatology,... Oct 2021Septic arthritis is a significant complication following arthroscopic surgery, with an estimated overall incidence of less than 1%. Despite the low incidence, an... (Review)
Review
PURPOSE
Septic arthritis is a significant complication following arthroscopic surgery, with an estimated overall incidence of less than 1%. Despite the low incidence, an appropriate diagnostic and therapeutic pathway is required to avoid serious long-term consequences, eradicate the infection, and ensure good treatment outcomes. The aim of this current review article is to summarize evidence-based literature regarding diagnostic and therapeutic options of post-operative septic arthritis after arthroscopy.
METHODS
Through a literature review, up-to-date treatment algorithms and therapies have been identified. Additionally, a supportive new algorithm is proposed for diagnosis and treatment of suspected septic arthritis following arthroscopic intervention.
RESULTS
A major challenge in diagnostics is the differentiation of the post-operative status between a non-infected hyperinflammatory joint versus septic arthritis, due to clinical symptoms, (e.g., rubor, calor, or tumor) can appear identical. Therefore, joint puncture for microbiological evaluation, especially for fast leukocyte cell-count diagnostics, is advocated. A cell count of more than 20.000 leukocyte/µl with more than 70% of polymorphonuclear cells is the generally accepted threshold for septic arthritis.
CONCLUSION
The therapy is based on arthroscopic or open surgical debridement for synovectomy and irrigation of the joint, in combination with an adequate antibiotic therapy for 6-12 weeks. Removal of indwelling hardware, such as interference screws for ACL repair or anchors for rotator cuff repair, is recommended in chronic cases.
LEVEL OF EVIDENCE
IV.
Topics: Arthritis, Infectious; Arthroscopy; Debridement; Humans; Synovectomy; Therapeutic Irrigation; Treatment Outcome
PubMed: 33755737
DOI: 10.1007/s00167-021-06525-8 -
The Journal of Hand Surgery Jun 2023Elbow arthritis is an uncommon condition that can cause debilitating pain, stiffness, or instability. The most common etiologies include rheumatoid arthritis,... (Review)
Review
Elbow arthritis is an uncommon condition that can cause debilitating pain, stiffness, or instability. The most common etiologies include rheumatoid arthritis, posttraumatic arthritis, and primary osteoarthritis. Treatment begins with nonsurgical modalities, including activity modification, anti-inflammatories, hand therapy, and corticosteroids. Operative intervention may be considered once nonsurgical management has failed. Surgical treatment depends on the underlying etiology, chief complaint, patient age, and functional demand. Advances in technology, especially arthroscopic techniques, have expanded the treatment options available to surgeons. The goals of treatment include pain relief and restoration of functional range of motion. The purpose of this article is to review the pertinent soft tissue and osseous anatomy, discuss the etiologies, review the principles of diagnosis and evaluation, and finally, study the treatment options for elbow arthritis.
Topics: Humans; Elbow; Elbow Joint; Arthroscopy; Arthritis, Rheumatoid; Range of Motion, Articular; Treatment Outcome
PubMed: 36759236
DOI: 10.1016/j.jhsa.2022.12.014 -
Haemophilia : the Official Journal of... Feb 2021Joint bleeds cause major morbidity in haemophilia patients. The synovial tissue is responsible for removal of blood remnants from the joint cavity. But blood components,... (Review)
Review
Joint bleeds cause major morbidity in haemophilia patients. The synovial tissue is responsible for removal of blood remnants from the joint cavity. But blood components, especially iron, lead to a series of changes in the synovial tissue: inflammation, proliferation and neovascularization. These changes make the synovium vulnerable to subsequent bleeding and as such a vicious cycle of bleeding-synovitis-bleeding may develop leading to chronic synovitis. The initial step in the treatment is adequate clotting factor supplementation and immediate physiotherapeutic involvement. If these measures fail, synovectomy may be indicated. Non-surgical options are chemical and radioactive synovectomy. This is a relatively non-invasive procedure to do synovectomy, leading to a reduction in pain and joint bleeds. Radioactive synovectomy seems more effective than chemical synovectomy in larger joints. Surgical options are open and arthroscopic synovectomy. Open synovectomy has been found to decrease the incidence of breakthrough bleeds but at the cost of loss of joint motion. Use of arthroscopic synovectomy has been advocated to reduce bleeding episodes with less morbidity to extra-articular tissue and preservation of joint motion. Use of a continuous passive motion (CPM) machine and early mobilization can decrease the postoperative stiffness and promote early recovery. This review addresses the current understanding of synovitis and its treatment options with specific emphasis on chemical and radioactive synovectomy and surgical options.
Topics: Arthroscopy; Hemophilia A; Humans; Knee Joint; Recurrence; Synovectomy; Synovitis
PubMed: 32490595
DOI: 10.1111/hae.14025 -
Inflammopharmacology Feb 2024Crude forms of musculoskeletal surgery have been performed through history for the treatment of deformity, pain and the horrors of battle. In more modern times Muller is...
Crude forms of musculoskeletal surgery have been performed through history for the treatment of deformity, pain and the horrors of battle. In more modern times Muller is credited with the first synovectomy in rheumatoid arthritis in 1884, and a Synovectomy was first performed by Richard von Volkmann (1830-1889) for joint tuberculosis. Chemical synovectomy consisting of the intra-articular injection of various agents was popular for a while but is now largely discarded. Joint resection for sepsis and tuberculosis has been documented since the early 1800s, and also joint arthrodesis, and osteotomy. Modern arthroscopic techniques have added the utility of faster intra-joint inspection and treatment while reduced surgical time exposure and often applied with the use of limb regional anaesthetic nerve blocks, to avoid general anaesthetic. Joint arthroplasty has been developed since1800s, with the use of many artificial joint components. There have been many notable pioneers of this work who are documented in this text, among them Austin T. Moore (1899-1963), George McKee (1906-1991) and Sir John Charnley (1911-1982). The success of joint arthroplasty to the hip, knee, shoulder and other joints has resulted in life-changing benefit for hundreds of arthritis and injury sufferers.
Topics: Humans; Arthritis, Rheumatoid; Injections, Intra-Articular; Knee Joint; Pain; Sepsis
PubMed: 37195498
DOI: 10.1007/s10787-023-01224-x -
Blood Reviews May 2019Radiosynovectomy (RS) is a simple, effective and safe procedure for the control of haemophilic synovitis that causes repetitive haemarthrosis. It must be done after... (Review)
Review
Radiosynovectomy (RS) is a simple, effective and safe procedure for the control of haemophilic synovitis that causes repetitive haemarthrosis. It must be done after confirming clinically (hard and painless mass on palpation) and by ultrasonography the existence of synovitis in a joint with recurrent haemarthrosis. RS should be the first invasive option (instead of arthroscopic synovectomy) for treatment of chronic synovitis. The technique is highly cost effective in comparison to arthroscopic synovectomy. The indication for RS is the presence of repeated haemarthroses associated with synovitis (confirmed clinically and by imaging techniques) that cannot be controlled by means of haematological treatment. No increase in the risk of cancer has been published and the dose of radiation utilized in RS is minimal. In haemophilic patients with recurrent haemarthrosis, RS should be performed under factor coverage as soon as possible, once the existence of synovitis has been confirmed by ultrasonography. RS should really be considered as a useful adjunctive procedure to the primary intervention, which is intensive replacement therapy.
Topics: Blood Coagulation Factor Inhibitors; Hemarthrosis; Hemophilia A; Hemophilia B; Humans; Isoantibodies; Magnetic Resonance Imaging; Radiotherapy; Surgery, Computer-Assisted; Synovectomy; Synovitis; Treatment Outcome; Ultrasonography
PubMed: 30704767
DOI: 10.1016/j.blre.2019.01.002 -
JBJS Reviews May 2016Synovial chondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia leading to cartilaginous nodules that ultimately break...
Synovial chondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The most commonly involved joint is the knee. Patients may be asymptomatic or may present with pain, swelling, and limited range of motion. Plain radiographs can be diagnostic and mineralized nodules are pathognomonic. Recommended treatment involves arthroscopic or open removal of loose bodies with or without a synovectomy to prevent further articular and periarticular destruction and to relieve symptoms.
Topics: Chondromatosis, Synovial; Humans; Joint Loose Bodies; Knee Joint; Radiography; Synovectomy
PubMed: 27490219
DOI: 10.2106/JBJS.RVW.O.00054 -
Operative Orthopadie Und Traumatologie Jun 2018Treatment of hallux rigidus by minimally invasive resection of the dorsal osteophytes, synovectomy and resection of the dorsal part of the metatarsal head. (Review)
Review
OBJECTIVES
Treatment of hallux rigidus by minimally invasive resection of the dorsal osteophytes, synovectomy and resection of the dorsal part of the metatarsal head.
INDICATIONS
Hallux rigidus grades II and III CONTRAINDICATIONS: End-stage osteoarthritis of the first metatarsophalangeal joint with beginning ankylosis.
SURGICAL TECHNIQUE
Osteophytes around the metatarsophalangeal joint are removed using a 1 cm incision dorsomedial, approximately 3 cm proximal of the joint space. The dorsal third of the metatarsal head is resected with a burr to improve dorsiflexion. The extent of bone resection is checked with an image intensifier. Loose bone fragments removed with a rangeur. An arthroscopy can be performed to check the completeness of bone resection, the irrigation of the joint and, if needed, to extend the synovectomy.
POSTOPERATIVE MANAGEMENT
Removal of the sutures after 2 weeks. Depending on pain, the patient can change from the postoperative shoe to a normal soft, comfortable and wide shoe after 1-2 weeks. Nonsteroidal drugs can be prescribed as needed. Active and passive mobilization of the metatarsophalangeal joint is also recommended.
RESULTS
The technique allows a soft-tissue-preserving resection of the osteophytes and a partial resection of the metatarsal head. The main advantages are limited soft-tissue trauma and rapid rehabilitation. In all, 21 women and 17 men with hallux rigidus stages II and III (Vanore) underwent surgery. Minimum follow-up was 12 months. In 1 patient, injury of the extensor hallucis longus tendon was observed. Two patients underwent revision surgery. One patient was converted to a metatarsophalangeal fusion, while another patient received a resection arthroplasty. At the latest follow-up, the AOFAS (American Orthopaedic Foot & Ankle Society) score averaged 88.7 points.
Topics: Arthroplasty; Female; Follow-Up Studies; Hallux; Hallux Rigidus; Humans; Male; Metatarsophalangeal Joint; Minimally Invasive Surgical Procedures; Treatment Outcome
PubMed: 29696322
DOI: 10.1007/s00064-018-0543-y -
Ugeskrift For Laeger Dec 2018In this review, function, anatomy and pathology of the sternoclavicular joint is described. Arthritis as part of a rheumatological condition is treated medically;... (Review)
Review
In this review, function, anatomy and pathology of the sternoclavicular joint is described. Arthritis as part of a rheumatological condition is treated medically; persistent synovitis can be treated by synovectomy. Infection is most often caused by Staphylococcus and is treated by debridement and antibiotics. Painful degenerative conditions can be treated by arthroscopic or open debridement, medial clavicle resection and resection of osteophytes. Instability can be traumatic or non-traumatic and is treated by a stabilising operation. Generally, results of treatment are positive.
Topics: Humans; Joint Diseases; Sternoclavicular Joint
PubMed: 30618359
DOI: No ID Found -
Ugeskrift For Laeger May 2022Lipoma arborescens is a rare benign villous proliferation of fatty tissue in joints. It is most often affecting the knee, but it has also been reported in other joints....
Lipoma arborescens is a rare benign villous proliferation of fatty tissue in joints. It is most often affecting the knee, but it has also been reported in other joints. It may result from chronic irritation but can also be a primary condition. It is diagnosed primarily on MRI combined with the clinical presentation. The surgical treatment of choice is arthroscopic synovectomy. This case report presents a 44-year-old woman with longstanding knee pain due to lipoma arborescens. With increased awareness of this disorder, patients can benefit from proper and timely surgery.
Topics: Adipose Tissue; Adult; Female; Humans; Knee Joint; Lipoma; Magnetic Resonance Imaging
PubMed: 35656617
DOI: No ID Found -
Revue Medicale de Liege Oct 2023Synovial chondromatosis is a rare pathology that involves most frequently the weight-bearing joints. It is due to the development of cartilaginous bodies from the...
Synovial chondromatosis is a rare pathology that involves most frequently the weight-bearing joints. It is due to the development of cartilaginous bodies from the synovial membrane that could migrate threw the joint. Primary and secondary forms exist. Clinical examination will be marked by swellings and loss of mobility. Cross-sectional imaging has the preference. The treatment of choice is the removal of cartilaginous loose bodies with or without a synovectomy.
Topics: Humans; Chondromatosis, Synovial; Synovectomy; Joint Loose Bodies
PubMed: 37830315
DOI: No ID Found