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Orthopaedics & Traumatology, Surgery &... Feb 2018Cutibacterium acnes is a commensal skin bacterium, regularly implicated in prosthetic joint infection, particularly of the shoulder. Diagnosis has been improved by... (Review)
Review
Cutibacterium acnes is a commensal skin bacterium, regularly implicated in prosthetic joint infection, particularly of the shoulder. Diagnosis has been improved by progress in bacteriological techniques: longer culture time, liquid medium culture, MALDI-TOF mass spectrography, and universal 16S rRNA PCR, associated by some authors to sonication of ablated implants. C. acnes pathogenicity involves many virulence factors, notably including biofilm formation. C. acnes may lead to infection that is clinically evident or, frequently, relatively asymptomatic. C. acnes is an anaerobic Gram-positive bacterium, susceptible to many antibiotics that are regularly used in bone and joint infection: beta-lactams, quinolone, rifampicin and clindamycin. It shows increasing resistance to clindamycin and natural resistance to metronidazole. Treatment is medical and surgical, associating synovectomy or complete 1- or 2-step revision depending on time to treatment, and antibiotic therapy. Antibiotic therapy is typically for three months with an initial 2-6 weeks' intravenous phase. Prognosis is generally favorable with well-conducted treatment. Late discovery of positive samples after apparently aseptic implant change is an at-risk situation, usually managed by antibiotic therapy, but with late initiation and hence increased risk of failure. Adverse secondary progression requires repeat revision under good conditions.
Topics: Anti-Bacterial Agents; Biofilms; Drug Resistance, Bacterial; Gram-Positive Bacterial Infections; Humans; Joint Prosthesis; Propionibacterium acnes; Prosthesis-Related Infections; Skin
PubMed: 29203432
DOI: 10.1016/j.otsr.2017.05.030 -
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 -
Der Orthopade Jul 2021Peroneal tendon pathologies are rare but often underdiagnosed. There may be an association with chronic lateral ankle instability as well as with varus hindfoot...
Peroneal tendon pathologies are rare but often underdiagnosed. There may be an association with chronic lateral ankle instability as well as with varus hindfoot alignment. Pathologies of the tendons fall into three categories: tendinitis and tenosynovitis, tendon ruptures and tears, and tendon subluxation and dislocation. Magnetic resonance imaging is the standard method for radiological assessment; however, the diagnosis and treatment are based primarily on patient history and clinical examination. A primary conservative treatment can be attempted, except for peroneal tendon dislocations in professional athletes. Surgical treatment should be targeted to the underlying pathology and can accordingly vary from tendoscopic synovectomy to anatomic repair of the superior peroneal retinaculum with deepening of the retromalleolar groove. Postoperative results show high patient satisfaction and low reluxation rates.
Topics: Ankle Injuries; Humans; Joint Dislocations; Tendinopathy; Tendon Injuries; Tendons
PubMed: 34160639
DOI: 10.1007/s00132-021-04116-6 -
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 -
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 -
Revista Brasileira de Ortopedia 2010A 34-year-old male patient presented severe pain in his left knee in association with functional incapacitation, with no apparent triggering factor. He sought medical...
A 34-year-old male patient presented severe pain in his left knee in association with functional incapacitation, with no apparent triggering factor. He sought medical attention in December 2006, at which time he was prescribed NSAIDs. After a year, he reported increased swelling and pain at the site. He was referred to a knee specialist with a suspected meniscal injury. Upon examination, severe swelling of the joint, with movement limitation, severe pain and negative joint aspiration, was found. Since the simple radiographic results were normal, an MRI of the knee was requested. The MRI revealed a large accumulation of fluid inside the joint, together with marked synovial proliferation, especially focal thickening in clumps with an intermediate signal in T1 and T2, and a discrete hyposignal in T2 that was suggestive of pigmented villonodular synovitis with intact meniscus and ligaments. The patient underwent arthroscopy on the left knee, which revealed whitish irregular fragments, and then underwent arthrotomy with removal of the lesion and extensive synovectomy. The material was sent for anatomopathological examination, which showed the presence of synovial chondromatosis. Eight months after the surgery, the patient does not have any complaints, with a range of motion of 130° in the left knee without joint effusion or signs of inflammation. Synovial chondromatosis is a rare benign type of metaplasia of the synovial membrane that leads to the formation of cartilaginous free bodies in the joint space. It is difficult to diagnose because 95% of the nodules, when not calcified, can be overlooked radiologically.
PubMed: 27047814
DOI: 10.1016/S2255-4971(15)30441-9 -
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 -
American Journal of Blood Research 2021Hemophilia is a bleeding disorder characterized by the deficiency of a coagulation factors. The hemarthrosis is the most common and earliest manifestation. Repeated... (Review)
Review
Hemophilia is a bleeding disorder characterized by the deficiency of a coagulation factors. The hemarthrosis is the most common and earliest manifestation. Repeated hemarthrosis over time causes the development of hemophilic arthropathy. Among most involved joints, the ankle is the one where much uncertainty remains about the best course of action in managing the various degrees of hemophilia manifestations. These manifestations range from simple acute swelling and pain to devastating deformity. The purpose of our review is to draw a comprehensive picture of ankle hemophilic arthropathy epidemiology, pathophysiology, clinical symptoms and signs, radiological features and all the treatments available at present days. This review confirms that the first line of treatment considered should be the replacement therapy of the coagulation deficient factors that, preventing hemarthrosis, stops the development and progression of ankle's joint damage. The treatments proposed in literature for advanced stage of arthropathy are many and vary according to the severity of the case. They range from conservative ones such as physiotherapy, orthosis, intra-articular injections, laser therapy, external beam radiation therapy, radio-synovectomy and oral drug to invasive surgical treatment such as ankle arthrodesis and total ankle replacement. Whatever is the chosen treatment, according to the arthropathy severity we believe that it must be carried out in reference centers for foot and ankle surgery assisted by expert hematologists.
PubMed: 34322283
DOI: No ID Found -
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 -
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