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Expert Review of Hematology 2023Most bleeding events in individuals with hemophilia occur within the ankle, knee, and elbow joints. Should the bleeding persist, the synovial membrane starts to... (Review)
Review
INTRODUCTION
Most bleeding events in individuals with hemophilia occur within the ankle, knee, and elbow joints. Should the bleeding persist, the synovial membrane starts to hypertrophy and a vicious cycle of chronic hemophilic synovitis (CHS) occurs, leading to joint destruction.
AREAS COVERED
This article covers the prompt diagnosis of CHS by point-of-care ultrasonography (POC-US) and its treatment by means of several types of synovectomy.
EXPERT OPINION
It is essential to prevent, detect and treat hemophilic synovitis, because it indicates that the joint has bled and is at risk of bleeding further. Prophylaxis with standard half life (SHL) factor VIII (FVIII) concentrate is the standard of care for individuals with severe hemophilia A and can also be considered for selected patients with moderate disease. Several years of real-world experience with extended half life (EHL) FVIII, emicizumab, and other drugs in development will be needed to ascertain their final effect on bleeding and its complications. We must look for synovitis in individuals declaring joint pain and in asymptomatic patients, and POC-US is the most reasonable imaging instrument with which to carry out periodic joint screening. Radiosynovectomy, chemical synovectomy, and arthroscopic synovectomy markedly reduce bleeding events.
Topics: Humans; Hemophilia A; Hemarthrosis; Synovitis; Synovectomy; Knee Joint
PubMed: 37119182
DOI: 10.1080/17474086.2023.2209717 -
Joint Bone Spine May 2018Radioisotope synovectomy has been extensively used to treat patients with chronic inflammatory joint disease but has moved to a less prominent position since the... (Review)
Review
Radioisotope synovectomy has been extensively used to treat patients with chronic inflammatory joint disease but has moved to a less prominent position since the introduction of new and highly effective drugs. Remaining indications are refractory synovitis, pigmented villonodular synovitis as an adjunct to surgery, and hemophilic arthropathy. The three main radioisotopes used are yttrium-90, rhenium-186, and erbium-189. Radioisotope synovectomy should be performed only by highly experienced professionals, to minimize the risk of injection-related complications. The available safety data, in particular regarding the risk of malignancy, are reassuring. The efficacy of yttrium-90 in chronic inflammatory joint disease remains controversial.
Topics: Arthritis; Brachytherapy; Chronic Disease; Female; Humans; Injections, Intra-Articular; Male; Prognosis; Radioisotopes; Rhenium; Risk Assessment; Severity of Illness Index; Synovectomy; Synovitis, Pigmented Villonodular; Treatment Outcome; Yttrium Radioisotopes
PubMed: 28652100
DOI: 10.1016/j.jbspin.2017.06.002 -
Sports Health 2017Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved... (Review)
Review
CONTEXT
Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved techniques has resulted in improved access to the hip joint and ability to treat various hip pathologies.
EVIDENCE ACQUISITION
Electronic databases, including PubMed and MEDLINE, were queried for articles relating to hip arthroscopy indications (1930-2017).
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
Initially used as a technique for loose body removal, drainage/debridement of septic arthritis, and treatment of pediatric hip disorders, hip arthroscopy is currently used to treat various hip conditions. The recognition of femoroacetabular impingement (FAI) as a source of hip pain in young adults has rapidly expanded hip arthroscopy by applying the principles of osseous correction that were previously described and demonstrated via an open surgical dislocation approach. Hip pathologies can be divided into central compartment, peripheral compartment, peritrochanteric space, and subgluteal space disorders.
CONCLUSION
Although hip arthroscopy is a minimally invasive procedure that may offer decreased morbidity, diminished risk of neurovascular injury, and shorter recovery periods compared with traditional open exposures to the hip, it is important to understand the appropriate patient selection and indications.
Topics: Arthritis, Infectious; Arthroscopy; Cartilage, Articular; Contraindications; Femoracetabular Impingement; Hip Injuries; Hip Joint; Humans; Joint Loose Bodies; Ligaments, Articular; Osteoarthritis, Hip; Patient Selection; Synovectomy; Synovial Membrane; Tendons
PubMed: 28678628
DOI: 10.1177/1941738117712675 -
Physica Medica : PM : An International... Mar 2018Rheumatoid arthritis (RA) is a chronic inflammatory disease that can potentially damage the synovial joints. One of the effective treatment modality for RA is radiation... (Review)
Review
Rheumatoid arthritis (RA) is a chronic inflammatory disease that can potentially damage the synovial joints. One of the effective treatment modality for RA is radiation synovectomy (RSV) where properly selected radionuclide is injected into the joint space, enabling controlled destruction of diseased synovial membrane via radiation exposure. Radiation dosimetry in RSV appears challenging due to the heterogeneous nature of synovial membrane, nonuniform distribution and leakage of radionuclide from the synovial cavity. This article reviews the dosimetric perspective pertaining to RSV. Specifically, characteristics of radionuclide for RSV and radiation dose to target and non-target (i.e., articular cartilage, bone, bloodstream, gonads, etc.) tissues of patient have been discussed. The personal dose H(0.07) to the hands of medical staff (i.e., radiochemist, therapist physician, nurse) may be considerably high due to handling of high specific activities (∼500 MBq/ml for Y-90); such doses are typically measured using thermoluminescence dosimeters (TLD) ring dosimeters and ranges from 1 to 21.5, 0.1 to 40 and 0.1 to 5 µSv/MBq for the radiochemist, therapist physician and the nurse, respectively. Methods to minimize radiation doses to the patient, medical staff and public are elaborated. Contamination risks and precautionary measures are also reported.
Topics: Arthritis, Rheumatoid; Humans; Neoplasms, Radiation-Induced; Organs at Risk; Radiation Dosage; Radiometry; Synovectomy
PubMed: 29609820
DOI: 10.1016/j.ejmp.2018.02.015 -
World Journal of Orthopedics Mar 2023Since the 1990s, new insights in wrist arthroscopy have led to the introduction of numerous treatment methods. Consequently, therapeutic procedures are no longer limited... (Review)
Review
Since the 1990s, new insights in wrist arthroscopy have led to the introduction of numerous treatment methods. Consequently, therapeutic procedures are no longer limited to resection as more specialized repair and functional reconstruction methods, involving tissue replacement and essential structural augmentation, have been shown to be beneficial. This article discusses the most prevalent reasons and uses for wrist arthroscopy, with an emphasis on Indonesia's most recent and major advances in reconstructive arthroscopic surgery. Joint debridement, synovectomy, ganglionectomy, capsular release, and osteotomies are frequent resection operations. Ligament repair and arthroscopy-aided reduction and fixation for fractures and nonunion are all examples of reconstructive surgery.
PubMed: 36998384
DOI: 10.5312/wjo.v14.i3.103 -
Hand Clinics Nov 2017Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical... (Review)
Review
Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist.
Topics: Arthritis, Rheumatoid; Arthroscopy; Humans; Synovectomy; Synovitis; Wrist Joint
PubMed: 28991588
DOI: 10.1016/j.hcl.2017.07.005 -
Orthopedics 2021Synovial chondromatosis of the finger is a rare metaplasia affecting either the finger joint or the tendon sheath. It is a benign extraosseus cartilage tumor that often... (Review)
Review
Synovial chondromatosis of the finger is a rare metaplasia affecting either the finger joint or the tendon sheath. It is a benign extraosseus cartilage tumor that often occurs in numbers and is not solitary in nature. This accumulation of masses within the finger can lead the patient to seek medical care. Symptoms are often painful and functionally disabling. Although rare, synovial chondromatosis must be considered in the differential diagnosis for patients with multiple lesions or masses within the hand and finger. Patient workup involves advanced imaging, including magnetic resonance imaging, ultrasonography, and computerized tomography. However, the results of these studies may be inconclusive. Conservative management can be discussed with the patient but has proven to be ineffective. Surgical excision is the recommended first-line treatment. Whether the surgery is arthroscopic or open, with or without synovectomy, is at the surgeon's discretion. Mass recurrence after surgery is an unfortunate complication, and subsequent treatment strategies are undefined. Recurrence may not occur at the same anatomical site. This condition can be intra-articular (within the figure joint) or extra-articular (within the tendon sheath or bursa). Revision surgery in the form of open excision with synovectomy is the mainstay of treatment. There have been only a few case reports of synovial chondromatosis involving the finger. This case series and up-to-date review of the literature presents a discussion of current surgical care. [. 2021;44(3):e454-e457.].
Topics: Chondromatosis, Synovial; Fingers; Humans; Recurrence; Synovectomy
PubMed: 33561871
DOI: 10.3928/01477447-20210201-05 -
Current Rheumatology Reviews 2018Rheumatoid Arthritis (RA) is an inflammatory disease with destructive pattern. Patients are suffering from pain and decreased functional outcome as the disease progress.... (Review)
Review
BACKGROUND
Rheumatoid Arthritis (RA) is an inflammatory disease with destructive pattern. Patients are suffering from pain and decreased functional outcome as the disease progress. Certain joints are widely discussed in the literature as well as shoulder girdle, but shoulder girdle surgical treatment options' indications and superiorities to each other were not compared entirely.
MATERIALS AND METHODS
Treatment options, such as; synovectomy and bursectomy, resection interposition arthroplasty, hemiarthroplasty, humeral resurfacing arthroplasty, anatomical total shoulder arthroplasty and reverse shoulder arthroplasty, are examined for their timing, advantages, disadvantages and comparison.
RESULTS
Patients' age is the main factor about the decision making in rheumatoid arthritis. Young aged patients demand high activity level, but as a result loosening of the implant is frequently encountered. Thus, the protection of the bone stock as much as possible must be the priority. For a young patient with disabling pain should be evaluated for less invasive surgeries such as; synovectomy and bursectomy, resection interposition arthroplasty and also for hemiarthroplasty for preservation of glenoid bone stock. But rotator cuff status, glenoid bone stock evaluation and grading of the glenoid defect become more important in old aged patients and the correct decision making can only be made by combining these factors.
CONCLUSIONS
Age, functional demand, rotator cuff status and adequacy of glenoid bone stock are defined as major criteria for an optimal treatment. Even though RA patients require additional care for a good functional outcome; with correct decision-making, high quality of life is achievable.
Topics: Adult; Age Factors; Aged; Arthritis, Rheumatoid; Biomechanical Phenomena; Clinical Decision-Making; Female; Health Status; Humans; Male; Middle Aged; Orthopedic Procedures; Patient Selection; Recovery of Function; Risk Factors; Shoulder Joint; Treatment Outcome; Young Adult
PubMed: 27908254
DOI: 10.2174/1573397112666161201161256 -
Current Opinion in Pediatrics Feb 2024Pigmented villonodular synovitis (PVNS) is a rare diagnosis in pediatric patients and commonly presents with symptoms of swelling and pain. Early diagnosis is important... (Review)
Review
PURPOSE OF REVIEW
Pigmented villonodular synovitis (PVNS) is a rare diagnosis in pediatric patients and commonly presents with symptoms of swelling and pain. Early diagnosis is important to prevent secondary degeneration into the subchondral bone. This review will analyze the etiology, clinical signs/symptoms, diagnosis, treatment, and recent literature on PVNS in the pediatric population.
RECENT FINDINGS
Many theories of PVNS etiology have been described in the literature; however, an inflammatory response has been most widely accepted. PVNS can occur in any joint, but most commonly in the knee. The most common treatment for PVNS is synovectomy, and long-term follow-up is necessary to detect disease persistence or recurrence.
SUMMARY
Although uncommon, PVNS does occur in the pediatric population and this diagnosis should be included in the differential of atraumatic joint swelling and pain.
Topics: Humans; Child; Synovitis, Pigmented Villonodular; Knee Joint; Giant Cell Tumors; Synovectomy; Pain
PubMed: 37994651
DOI: 10.1097/MOP.0000000000001312 -
Reumatologia 2016Radionuclide synovectomy is a minimally invasive method of treating persistent joint inflammation. It involves intra-articular injection of radioactive colloids which... (Review)
Review
Radionuclide synovectomy is a minimally invasive method of treating persistent joint inflammation. It involves intra-articular injection of radioactive colloids which induce necrosis and fibrosis of hypertrophic synovial membrane. The most common indication for radiosynovectomy is rheumatoid arthritis, although patients with seronegative spondyloarthropathies, unclassified arthritis, haemophilic arthropathy and other less common arthropathies can also benefit from this method. Radiosynovectomy is safe, well tolerated and efficacious. About 70-80% of patients respond well to the therapy. However, the therapeutic effects are considerably worse in patients with co-existent osteoarthritis and advanced joint degeneration. Despite its advantages, radionuclide synovectomy is not performed as often as it could be, so greater knowledge and understanding of this method are needed. The authors present the most important facts about radiosynovectomy that may help rheumatologists in their daily clinical practice.
PubMed: 27504020
DOI: 10.5114/reum.2016.61210