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BMJ Case Reports Jan 2022Synovial chondromatosis is a rare, benign condition occurring due to metaplasia of synovium. A 65-year-old woman presented with pain in her right hip for 6 years. On...
Synovial chondromatosis is a rare, benign condition occurring due to metaplasia of synovium. A 65-year-old woman presented with pain in her right hip for 6 years. On examination, a swelling was palpable at the base of scarpa's triangle and her right hip movements were restricted. Imaging modalities showed ossified nodules in the antero-inferior aspect of the hip joint, joint effusion and arthritic changes. We diagnosed the patient to have synovial chondromatosis with secondary arthritis of the hip joint. We performed a total hip arthroplasty with simultaneous synovectomy and extraction of the osteochondral loose bodies, 5 of which were about 2×2 cm in size. We found that excessive acetabular reaming was required due to craters, the osteochondral masses formed on the acetabular surface. Histopathological analysis confirmed the diagnosis. The patient had an excellent functional outcome and no recurrence 5 years following the surgery.
Topics: Aged; Arthroplasty, Replacement, Hip; Chondromatosis, Synovial; Female; Hip Joint; Humans; Joint Loose Bodies; Synovectomy
PubMed: 35064037
DOI: 10.1136/bcr-2021-246039 -
Der Orthopade Nov 2018Orthopaedic and traumatologic involvement in patients with rheumatic diseases require extensive knowledge of these immunologically impairing illnesses. This concerns... (Review)
Review
Orthopaedic and traumatologic involvement in patients with rheumatic diseases require extensive knowledge of these immunologically impairing illnesses. This concerns both the handling of medication and conservative treatment. The destructive processes of the joints and the spine follow established pathways. Various operating procedures are helpful depending on the stage of articular destruction. The special features of the entire perioperative management of affected persons has to be observed. Soft tissue surgical interventions are followed by arthrodesis or arthroplasty in later courses of destruction. In Germany, the orthopaedic rheumatologist specializes in the conservative and surgical treatment of inflammatory systemic diseases. Audited centres for operative interventions of the German Society for Orthopaedic Rheumatology (DGORh) seem to be the best fit for this purpose.
Topics: Arthritis, Rheumatoid; Arthrodesis; Arthroplasty; Germany; Humans
PubMed: 30357427
DOI: 10.1007/s00132-018-03657-7 -
Orthopaedics & Traumatology, Surgery &... Dec 2015Septic arthritis develops after less than 1% of all arthroscopy procedures. The clinical symptoms may resemble those seen after uncomplicated arthroscopy, raising... (Review)
Review
Septic arthritis develops after less than 1% of all arthroscopy procedures. The clinical symptoms may resemble those seen after uncomplicated arthroscopy, raising diagnostic challenges. The diagnosis rests on emergent joint aspiration with microscopic smear examination and prolonged culturing on specific media. Urgent therapeutic measures must be taken, including abundant arthroscopic lavage, synovectomy, and the concomitant administration of two effective antibiotics for at least 6 weeks. Preservation of implants or transplants is increasingly accepted, and repeated joint lavage is a component of the treatment strategy. After knee arthroscopy, infection is the most common complication; most cases occur after cruciate ligament reconstruction, and staphylococci are the predominant causative organisms. Emergent synovectomy with transplant preservation and appropriate antibiotic therapy ensures eradication of the infection in 85% of cases, with no adverse effect on final functional outcomes. After shoulder arthroscopy, infection is 10 times less common than neurological complications and occurs mainly after rotator cuff repair procedures; the diagnosis may be difficult and delayed if Propionibacterium acnes is the causative organism. The update presented here is based on both a literature review and a practice survey. The findings have been used to develop practical recommendations aimed at improving the management of post-arthroscopy infections, which are exceedingly rare but can induce devastating functional impairments.
Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Arthroscopy; Gram-Positive Bacterial Infections; Humans; Knee Joint; Male; Middle Aged; Practice Patterns, Physicians'; Propionibacterium acnes; Shoulder Joint; Staphylococcal Infections; Surveys and Questionnaires; Synovectomy; Therapeutic Irrigation
PubMed: 26412207
DOI: 10.1016/j.otsr.2015.09.004 -
Blood Coagulation & Fibrinolysis : An... Sep 2019: The role of the orthopedic surgeon is to use invasive and/or surgical methods to treat the musculoskeletal disorders suffered by persons with hemophilia, always within...
: The role of the orthopedic surgeon is to use invasive and/or surgical methods to treat the musculoskeletal disorders suffered by persons with hemophilia, always within the context of a multidisciplinary team. Muscle hematomas must be diagnosed as early as possible and be subjected to continuous treatment until full resolution, as they are associated with the risk of severe complications (compartment syndromes and pseudotumors). Arthrocentesis (extraction of intra-articular blood) is recommended in cases of acute and profuse hemarthrosis. Synovectomy is mandatory in the case of synovitis. Radiosynovectomy plays a key role as it has been shown to reduce bleeding by 65%. Our department uses Yttrium-90 in knees and Rhenium-186 in elbows and ankles. Radiosynovectomy is our treatment of choice for synovitis whereas arthroscopic synovectomy is resorted to as second-line treatment. Total knee replacement (TKR) has shown itself to be effective for treating severe hemophilic arthropathy, although the infection risk in patients with hemophilia is higher than in patients with osteoarthritis (1-2 vs. 7%).
Topics: Arthroplasty, Replacement, Knee; Hemarthrosis; Hemophilia A; Humans; Joint Diseases; Radioisotopes; Rhenium; Synovectomy; Synovitis; Yttrium Radioisotopes
PubMed: 31517710
DOI: 10.1097/MBC.0000000000000824 -
The Journal of the American Academy of... Sep 2019Recurrent hemarthrosis (RH) is a rare complication (∼1%) after total knee arthroplasty (TKA). It is a complex and particularly frustrating problem for both patient and... (Review)
Review
Recurrent hemarthrosis (RH) is a rare complication (∼1%) after total knee arthroplasty (TKA). It is a complex and particularly frustrating problem for both patient and surgeon. Typically, patients present several months to years after their index TKA surgery with a painful and swollen joint. Although conservative management may provide temporary relief, the rate of recurrence is high. Despite extensive case series in the literature, no consensus was made on the criteria needed to establish this diagnosis, or how to best provide treatment. Several management strategies have been described for RH, including immobilization, arthroscopic versus open synovectomy, angiographic embolization, and revision arthroplasty. All of these have demonstrated variable effectiveness, with limited evidence for their use in specific situations. This review synthesizes the available literature and suggests an algorithm for the diagnosis and treatment of RH after TKA.
Topics: Arthroplasty, Replacement, Knee; Embolization, Therapeutic; Hemarthrosis; Humans; Physical Examination; Postoperative Complications; Recurrence; Reoperation; Synovectomy
PubMed: 30720569
DOI: 10.5435/JAAOS-D-18-00182 -
Journal of Orthopaedic Surgery (Hong... Dec 2014Studies published in MEDLINE between January 2010 and October 2013 were reviewed to compare open with arthroscopic synovectomy for pigmented villonodular synovitis of... (Comparative Study)
Comparative Study Review
Studies published in MEDLINE between January 2010 and October 2013 were reviewed to compare open with arthroscopic synovectomy for pigmented villonodular synovitis of the knee in terms of rates of recurrence, complication, and osteoarthritis. 10 studies specifically on this topic were analysed; all were retrospective case reports, and thus level of evidence was low. Respectively after open and arthroscopic synovectomy, the overall recurrence rates were 26.7% and 24.6%, the overall complication rates were 5.7% and 3.2%, and the overall osteoarthritis rates were 20% and 17.1%. Arthroscopic and open synovectomy did not differ significantly in terms of rates of recurrence, complication, and osteoarthritis. Prospective randomised studies are needed to confirm the findings.
Topics: Arthroscopy; Humans; Knee Joint; Neoplasm Recurrence, Local; Osteoarthritis, Knee; Postoperative Complications; Synovectomy; Synovitis, Pigmented Villonodular
PubMed: 25550027
DOI: 10.1177/230949901402200327 -
Zeitschrift Fur Orthopadie Und... Feb 2018There are several therapeutic options for the treatment of periprosthetic joint infections of shoulder arthroplasties. In acute infections, the implant can remain in... (Review)
Review
There are several therapeutic options for the treatment of periprosthetic joint infections of shoulder arthroplasties. In acute infections, the implant can remain in place with open debridement, septic lavage with antibacterial solutions such as octinedine or polyhexanide solution and exchange of all mobile components. In late infections, the therapeutic options after removal of the infected implant are: permanent spacer, resection arthroplasty, one stage revision and two stage revision with or without a temporary spacer. The functional results are best for one stage revisions, with similar prosthetic survival to two stage revisions. For one stage revisions, the microorganism has to be identified prior to revision surgery, in order to use targeted antibiotics locally in the cement, and systemically.
Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Shoulder; Combined Modality Therapy; Debridement; Device Removal; Early Diagnosis; Early Medical Intervention; Female; Humans; Male; Prosthesis-Related Infections; Reoperation; Risk Factors; Shoulder Prosthesis; Surgical Wound Infection; Synovectomy; Therapeutic Irrigation
PubMed: 28835000
DOI: 10.1055/s-0043-116942 -
The Journal of Foot and Ankle Surgery :... 2014Septic arthrosis of the ankle is a rare, often devastating, infection, with a high potential for morbidity and mortality. Delay in treatment can lead to cartilage... (Review)
Review
Septic arthrosis of the ankle is a rare, often devastating, infection, with a high potential for morbidity and mortality. Delay in treatment can lead to cartilage erosion, painful synovitis, and osteomyelitis. Septic ankle arthrosis deserves prompt recognition and intervention. However, quality, sound, protocol-directed arthroscopic treatment of septic ankle arthrosis of the ankle has not yet been reported. We performed a systematic review of the electronic databases and other relevant peer-reviewed sources to determine the outcomes and treatment protocols associated with septic ankle arthrosis treated with arthroscopic synovectomy, irrigation, and debridement. Nine studies, involving a total of 15 ankles, met our inclusion criteria. In addition, we present the short-term outcomes of a protocol-driven arthroscopic synovial biopsy, deep culture procurement, synovectomy, irrigation, and debridement approach for 8 ankles (8 patients). To our knowledge, this would be the largest individual case series specific to arthroscopic treatment of septic ankle arthrosis. The most common infectious organism reported in the systematic review and in our case series was methicillin-sensitive Staphylococcus aureus. Arthroscopic synovectomy, irrigation, and debridement represents an acceptable treatment method for septic ankle arthrosis and demonstrated outcomes similar to the more traditional open approach, with fewer complications. Additional, appropriately weighted, randomized controlled studies with long-term follow-up are warranted.
Topics: Ankle Joint; Anti-Bacterial Agents; Arthritis, Infectious; Arthroscopy; Clinical Protocols; Debridement; Humans; Staphylococcal Infections; Staphylococcus aureus; Synovectomy; Therapeutic Irrigation
PubMed: 24345707
DOI: 10.1053/j.jfas.2013.10.012 -
Romanian Journal of Morphology and... 2020Idiopathic tenosynovitis with rice bodies is a rare disease and its non-association with rheumatic diseases, tuberculosis infection or trauma is reported only in few...
PURPOSE
Idiopathic tenosynovitis with rice bodies is a rare disease and its non-association with rheumatic diseases, tuberculosis infection or trauma is reported only in few cases in literature.
PATIENTS, MATERIALS AND METHODS
Our study presents a series of five patients diagnosed with tenosynovitis with rice bodies at the flexor tendons of the upper limb. Medical history revealed no associated disease or trauma. Disease duration ranged between two months and four years, two patients presenting symptoms of acute carpal tunnel and three patients tumor mass. In one case, the tumor measured 210 mm in length and a tendon rupture was suspected. Laboratory and imaging investigations could not establish a specific associated pathology and a preoperative diagnosis. Surgical treatment consisting of synovectomy was performed in all patients.
RESULTS
In all five cases, intraoperative appearance could easily determine the presence of rice bodies. Histopathological examination revealed typical aspect for rice bodies and make the diagnosis possible without the need for other more laborious processing (immunohistochemistry). The amount of rice bodies was directly proportional to disease duration. In all cases, the recovery was complete. After a median 30.4-month follow-up, no recurrence was detected. Subsequently performed laboratory investigations and specific tests did not reveal tuberculosis infection, rheumatic disease, or other diseases.
CONCLUSIONS
This is the largest series of patients with idiopathic tenosynovitis with rice bodies and the bigger tumor mass reported to date. Synovectomy with removal of all rice bodies represents the optimal treatment. A longer disease course may be associated with a larger number of rice bodies, which may be associated with tendon rupture. The etiopathogenesis remains unclear, further studies being necessary to establish it.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Tenosynovitis
PubMed: 33544797
DOI: 10.47162/RJME.61.2.15 -
Modern Rheumatology Case Reports Jan 2022Rice bodies are a rare finding in medicine and offer a therapeutic challenge. As their occurrence varies over multiple rheumatic as well as infectious diseases, multiple...
Rice bodies are a rare finding in medicine and offer a therapeutic challenge. As their occurrence varies over multiple rheumatic as well as infectious diseases, multiple hypotheses have been made about their origin. While rice bodies are most frequently reported in the shoulder and knee joints, flexor tendon synovitis with accompanying rice bodies is rarer. We report a case of extensive flexor tenosynovitis with rice bodies in the wrist in a 90-year-old patient with seronegative rheumatoid arthritis. The patient reported a 5-month history of painful swelling of the right wrist. Ultrasound showed pronounced swelling of the synovial tissue of the flexor tendons. Laboratory test were negative for rheumatology tests with normal C-reactive protein and sedimentation rates. T2-weighted magnetic resonance imaging demonstrated an extensive synovitis reaching from the distal forearm into the hand with inclusions, better known as rice bodies. Synovectomy including carpal tunnel release was performed with dissection of the mass revealing an extensive synovitis with a multitude of rice bodies. Histopathology showed lymphohistiocytic infiltrates consistent with rheumatoid nodules. After surgery, the patient regained full function of the wrist within 2 weeks without any pain or remaining mass in the affected limb.
Topics: Aged, 80 and over; Humans; Synovectomy; Tendons; Tenosynovitis; Wrist; Wrist Joint
PubMed: 34614514
DOI: 10.1093/mrcr/rxab040