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Current Reviews in Musculoskeletal... Jun 2016Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by peripheral polyarthritis. The elbow joint is estimated to be involved in 20 to 65 % of the... (Review)
Review
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by peripheral polyarthritis. The elbow joint is estimated to be involved in 20 to 65 % of the patients with RA. The development of new pharmacologic agents and the adoption of early therapeutic interventions have translated into milder forms of polyarticular destruction. As a result, the traditional crippled rheumatoid patient has been replaced by rheumatoid patients with higher activity levels, higher expectations, and more demands on any reconstructive procedures performed. When nonoperative treatment is insufficient, surgery may be considered. Arthroscopic synovectomy has become the procedure of choice for rheumatoid patients with uncontrolled symptoms. Patients with more advanced joint destruction can be considered for elbow arthroplasty. Interposition arthroplasty may be considered for patients interested in avoiding the potential complications of elbow arthroplasty.
PubMed: 27056576
DOI: 10.1007/s12178-016-9328-9 -
The Journal of Knee Surgery May 2017The objective of this study is to assess pain, function, and morbidity in patients undergoing synovectomy during primary total knee arthroplasty (TKA) for osteoarthritis... (Meta-Analysis)
Meta-Analysis Review
The objective of this study is to assess pain, function, and morbidity in patients undergoing synovectomy during primary total knee arthroplasty (TKA) for osteoarthritis (OA). A meta-analysis, which included randomized controlled trials comparing TKA with and without synovectomy for OA, was completed. The primary outcome was postoperative knee pain. Secondary outcomes included performance, perioperative complications, validated functional scores, operation length, and hospitalization length. A literature search produced 487 unique references, of which 3 randomized controlled trials were selected for inclusion. A total of 304 patients (354 knees) were included, with an average age of 67 years. Follow-up intervals between studies ranged from 26 weeks to 12 months. Included studies were of moderate- to high-quality evidence with low risk of bias. There was no significant difference between the two groups in regard to postoperative pain, Knee Society Score, or postoperative range of motion. Postoperative blood loss was significantly lower in synovium-retaining TKA group (MD = 99.41 mL; 95% confidence interval, 45.08-153.75). Based on these results, there is currently no evidence to support the use of synovectomy in TKA for primary OA, as it provides no clinical benefit and increases postoperative blood loss.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Osteoarthritis, Knee; Pain, Postoperative; Postoperative Hemorrhage; Range of Motion, Articular; Synovectomy
PubMed: 27380472
DOI: 10.1055/s-0036-1584560 -
Skeletal Radiology Jun 2020A variety of benign and neoplastic lesions can affect the synovium, including pigmented villonodular synovitis (PVNS) and synovial chondromatosis. Prior to surgical...
OBJECTIVE
A variety of benign and neoplastic lesions can affect the synovium, including pigmented villonodular synovitis (PVNS) and synovial chondromatosis. Prior to surgical resection, accurate characterization of synovial lesions is necessary for appropriate treatment planning. Additionally, recent advances in potential medical therapies for PVNS could decrease or eliminate the need for surgery in some cases. Such treatment options demand accurate characterization of synovial lesions prior to treatment.
METHODS AND MATERIALS
Institutional IRB approval was obtained. We identified 54 synovial biopsies performed at our institution using a comprehensive database search under ultrasound (US) or computed tomography (CT) guidance. Cases were reviewed for pre-procedure imaging, location, biopsy approach, biopsy results, post-procedure complications, and surgical pathology if synovectomy was performed.
RESULT
A total of 54 image-guided synovial biopsies were performed, 36 using CT guidance and 18 using US guidance. Six different anatomic locations were biopsied (the hip, knee, shoulder, elbow, ankle, and temporomandibular joint). Synovial tissue was obtained in 89% of cases (48/54). CT-guided biopsies had a positive yield of 86% (31/36) and US-guided biopsies had a positive yield of 94% (17/18). Surgical pathology was obtained in 30 of the cases and image-guided biopsy concordance was 90% (27/30). Of the patients taken for synovectomy, biopsy concordance of suspected neoplastic lesions was 100% (23/23). In cases of suspected neoplasm, the concordance between image-guided biopsy and surgical pathology was 96% (22/23). There were no reported complications.
CONCLUSION
Image-guided biopsy of synovial lesions is safe and effective for establishing a definitive diagnosis prior to surgical or other intervention.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chondromatosis, Synovial; Female; Humans; Image-Guided Biopsy; Male; Middle Aged; Radiography, Interventional; Retrospective Studies; Synovectomy; Synovitis, Pigmented Villonodular; Tomography, X-Ray Computed; Ultrasonography, Interventional
PubMed: 31912178
DOI: 10.1007/s00256-019-03370-2 -
Operative Orthopadie Und Traumatologie Dec 2014Pain reduction in the affected metacarpophalangeal joint (MP joint) by synovectomy, loose body extraction and resection of intraarticular scars.
OBJECTIVE
Pain reduction in the affected metacarpophalangeal joint (MP joint) by synovectomy, loose body extraction and resection of intraarticular scars.
INDICATIONS
Synovitis in rheumatoid arthritis (RA) not responding to antirheumatic treatment, primary and secondary degenerative arthritis, osteochondral lesions, loose bodies, foreign bodies, capsular contracture, septic arthritis, posttraumatic arthralgia (old collateral ligament injury), intraarticular fractures.
CONTRAINDICATIONS
Established biomechanical changes in RA such as ulnar deviation and palmar subluxation with extensor tendon luxation of the MP joint. Advanced radiologic changes in degenerative arthritis. Joint instability in posttraumatic conditions. Fresh skin lesion near portals.
SURGICAL TECHNIQUE
Longitudinal traction of the affected finger in a Chinese finger trap. The joint is filled with Ringer solution. Placement of a radial and ulnar dorsal portal at joint space level, through the extensor hood, at the dorsal border of the collateral ligaments. Diagnostic arthroscopy. In case of insufficient visibility (i.e., bulky synovitis in RA) "blind" shaving in the dorsal recess at first. Completion of synovectomy under sight. If necessary additional ablation of synovial tissue by a radiofrequency (RF) electrosurgical system. Use of arthroscope (1.9 mm) with a 30° angle of vision and shaver (aggressive cutter; 2.0 mm). Low-suction drain, soft padded dressing.
POSTOPERATIVE MANAGEMENT
Immediate postoperative mobilization for the full range of finger movement.
RESULTS
In 106 MP joint arthroscopies from 2009-2011, very high patient satisfaction was achieved. Best results were obtained in RA, even in advanced radiologic changes (Larsen stages 1-3). Only in Larsen stage 4 results were rated lower. In early stages of degenerative arthritis (Kellgren-Lawrence 0-2), patient satisfaction was also very high, however decreased rapidly with increasing degree of radiologic changes. The results in posttraumatic cases are promising.
Topics: Arthroplasty; Finger Injuries; Humans; Metacarpophalangeal Joint; Retrospective Studies; Synovitis; Treatment Outcome
PubMed: 25452092
DOI: 10.1007/s00064-014-0313-4 -
Journal of Clinical Medicine Dec 2022A radiosynovectomy (RS) should be indicated when recurrent articular bleeds related to chronic hemophilia synovitis (CHS) exist, established by clinical examination, and... (Review)
Review
A radiosynovectomy (RS) should be indicated when recurrent articular bleeds related to chronic hemophilia synovitis (CHS) exist, established by clinical examination, and confirmed by imaging techniques that cannot be constrained with hematological prophylaxis. RS can be performed at any point in life, mainly in adolescents (>13−14 years) and adults. Intraarticular injection (IAI) of a radioactive material in children might be arduous since we need child collaboration which might include general anesthesia. RS is our initial option for management of CHS. For the knee joint we prescribe Yttrium-90, while for the elbow and ankle we prescribe Rhenium-186 (1 to 3 IAIs every 6 months). The procedure is greatly cost efficient when compared to surgical synovectomy. Chemical synovectomy with rifampicin has been reported to be efficacious, inexpensive, simple, and especially practical in developing countries where radioactive materials are not easily available. Rifampicin seems to be more efficacious when it is utilized in small joints (elbows and ankles), than when utilized in bigger ones (knees). When RS and/or chemical synovectomy fail, arthroscopic synovectomy (or open synovectomy in some cases) should be indicated. For us, surgery must be performed after the failure of 3 RSs with 6-month interims. RS is an effective and minimally invasive intervention for treatment of repeated articular bleeds due to CHS. Although it has been published that the risk of cancer does not increase, and that the amount of radioactive material used in RS is insignificant, the issue of chromosomal and/or deoxyribonucleic acid (DNA) changes remains a concern and continued surveillance is critical. As child and adulthood prophylaxis becomes more global, RS might become obsolete in the long-term.
PubMed: 36556091
DOI: 10.3390/jcm11247475 -
The Bone & Joint Journal Apr 2015Pigmented villonodular synovitis (PVNS) is a rare proliferative process of the synovium which most commonly affects the knee and occurs in either a localised (LPVNS) or... (Meta-Analysis)
Meta-Analysis Review
Pigmented villonodular synovitis (PVNS) is a rare proliferative process of the synovium which most commonly affects the knee and occurs in either a localised (LPVNS) or a diffuse form (DPVNS). The effect of different methods of surgical synovectomy and adjuvant radiotherapy on the rate of recurrence is unclear. We conducted a systematic review and identified 35 observational studies in English which reported the use of surgical synovectomy to treat PVNS of the knee. A meta-analysis included 630 patients, 137 (21.8%) of whom had a recurrence after synovectomy. For patients with DPVNS, low-quality evidence found that the rate of recurrence was reduced by both open synovectomy (odds ration (OR) = 0.47; 95% CI 0.25 to 0.90; p = 0.024) and combined open and arthroscopic synovectomy (OR = 0.19, 95% CI = 0.06 to 0.58; p = 0.003) compared with arthroscopic surgery. Very low-quality evidence found that the rate of recurrence of DPVNS was reduced by peri-operative radiotherapy (OR = 0.31, 95% CI 0.14 to 0.70; p = 0.01). Very low-quality evidence suggested that the rate of recurrence of LPVNS was not related to the surgical approach. This meta-analysis suggests that open synovectomy or synovectomy combined with peri-operative radiotherapy for DPVNS is associated with a reduced rate of recurrence. Large long-term prospective multicentre observational studies, with a focus on both rate of recurrence and function, are required to confirm these findings.
Topics: Humans; Knee Joint; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant; Synovectomy; Synovitis, Pigmented Villonodular
PubMed: 25820897
DOI: 10.1302/0301-620X.97B4.34907 -
Rheumatology (Oxford, England) Feb 2021The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to... (Review)
Review
The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to inspect joints to assess synovial conditions that concern rheumatologists. Rheumatologists were among the pioneers developing arthroscopy. Students of the father of modern arthroscopy, Watanabe, included rheumatologists, who taught others once home. Rheumatologists assessed the intra-articular features of their common diseases in the 60s and 70s. Improvements in instrumentation and efforts by a few orthopaedists adapted a number of common joint surgical procedures for arthroscopy. Interest from rheumatologists in arthroscopy grew in the 90s with 'needle scopes' used in an office setting. Rheumatologists conducting the first prospective questioning arthroscopic debridement in OA and developing biological compounds reduced the call for arthroscopic interventions. The arthroscope has proven an excellent tool for viewing and sampling synovium, which continues to at several international centres. Some OA features-such as calcinosis-beg further arthroscopic investigation. A new generation of 'needle scopes' with far superior optics awaits future investigators.
Topics: Arthritis, Rheumatoid; Arthroscopy; Humans; Rheumatology; Synovectomy
PubMed: 33257961
DOI: 10.1093/rheumatology/keaa560 -
Orthopaedics & Traumatology, Surgery &... May 2019In patients with rheumatoid arthritis, the surgical treatment of wrist lesions relies on synovectomy combined with stabilisation and realignment of the carpal bones. The... (Observational Study)
Observational Study
BACKGROUND
In patients with rheumatoid arthritis, the surgical treatment of wrist lesions relies on synovectomy combined with stabilisation and realignment of the carpal bones. The objective of this study was to evaluate the outcomes and define the indications of extensor carpi radialis longus (ECRL) transfer to the extensor carpi ulnaris (ECU) as described by Clayton and Ferlic.
HYPOTHESIS
ECRL-to-ECU transfer combined with synovectomy can prevent the development and/or progression of rheumatoid deformities at the wrist.
MATERIAL AND METHODS
A retrospective observational study was performed in 16 wrists. The following data were collected before and after surgery: pain, synovitis, range of motion, carpal height, ulnar translocation and radial deviation of the carpal bones, and Larsen's grade of the radio-carpal and mid-carpal joints.
RESULTS
After a mean follow-up of 42.5 months after surgery, pain relief was noted in 14 cases and synovitis resolution in 10 cases. Mean mobility gains were 19.7° in extension and 5.7° in flexion. The radiographs showed a decrease in carpal height, whereas radial deviation and ulnar translocation were unchanged. No change was seen in the radio-carpal and mid-carpal joint lines. In the 3 wrists that required mid-carpal arthrodesis due to advanced disease before surgery, the radio-carpal joint line was unchanged and outcomes were the same as in the overall population.
DISCUSSION
ECRL-to-ECU transfer combined with synovectomy provides pain relief and prevents radio-carpal destabilisation. The main indication of ECRL transfer is reducible radial deviation and ulnar translocation. ECRL is also indicated in combination with mid-carpal arthrodesis in the small minority of patients who have predominant mid-carpal involvement with a Larsen grade greater than 2.
LEVEL OF EVIDENCE
IV, retrospective observational study.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Female; Follow-Up Studies; Humans; Male; Middle Aged; Radiography; Range of Motion, Articular; Retrospective Studies; Synovectomy; Tendon Transfer; Time Factors; Wrist Joint; Young Adult
PubMed: 30503725
DOI: 10.1016/j.otsr.2018.08.020 -
Bulletin of the Hospital For Joint... Mar 2019Juvenile idiopathic arthritis is a heterogeneous group of conditions encompassing all forms of unknown origin arthritis before the age of 16 years that persist for more... (Review)
Review
Juvenile idiopathic arthritis is a heterogeneous group of conditions encompassing all forms of unknown origin arthritis before the age of 16 years that persist for more than 6 weeks. It is the most common rheumatic disease in young patients and causes severe disabilities, thus an early initiation of the appropriate treatment modalities is necessary. First therapeutic options are nonsteroidal anti-inflammatory drugs, corticosteroids, and conventional non-biologic disease-modifying anti-rheumatic drugs, such as methotrexate. Insufficiency of these drugs led to the introduction of new biological medications that selectively target specific cytokines with an objective to suppress the disease. Despite the success in treatment and physical therapy, some of the patients develop advanced arthritis that can result in severe pain and disability. In such cases, surgical intervention is required to improve quality of life. The surgical methods include soft tissue release, osteotomies, synovectomies, and arthrodesis. Total joint replacement is the last option for endstage degenerative conditions (patients with deformity, poor motion, and severe pain). Deep infections, bone perforation, acetabular protrusion, postoperative dislocations, and the need for re-operation are some of the complications of total joint arthroplasty. This review summarizes published studies of the treatment of juvenile idiopathic arthritis focusing mainly on surgical treatment. Our purpose is to evaluate the general trends in treatment of juvenile idiopathic arthritis, focusing on methods, therapeutic advances, and outcomes of the intervention applied.
Topics: Adolescent; Arthritis, Juvenile; Conservative Treatment; Humans; Postoperative Complications; Quality of Life; Reoperation; Surgical Procedures, Operative; Treatment Outcome
PubMed: 31128579
DOI: No ID Found -
JBJS Reviews Aug 2017
Review
Topics: Arthroscopy; Evidence-Based Medicine; Female; Hemarthrosis; Hemophilia A; Humans; Knee; Male; Radiography; Synovectomy; Synovitis; Treatment Outcome
PubMed: 28832348
DOI: 10.2106/JBJS.RVW.16.00100