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Antibiotics (Basel, Switzerland) Jul 2023Synovitis, like that associated with chronic bacterial arthritis, is a very rare finding during the implantation of knee endoprostheses. In such cases, we fix the knee...
BACKGROUND
Synovitis, like that associated with chronic bacterial arthritis, is a very rare finding during the implantation of knee endoprostheses. In such cases, we fix the knee prostheses with cement containing two antibiotics and carry out a course of systemic antibiotic administration. The aim was to analyze these cases for incidence, detection of bacteria, risk factors, and outcome.
METHODS
Out of 7534 knee replacements between January 2013 and December 2020, 25 cases were suspected during the surgical procedure to have suffered from bacterial arthritis and were treated accordingly. Total synovectomy was carried out, whereby five intraoperative synovial samples were examined bacteriologically, and the complete synovitis was analyzed histologically. The mean follow-up was 65.3 ± 27.1 (24-85) months.
RESULTS
In nine cases (0.12%), the diagnosis of bacterial arthritis was made histologically and by clinical chemistry (elevated CRP), and in two of these cases, pathogen verification was performed. Eight of these nine patients had previously had injections or surgery associated with the corresponding knee joint or had an underlying immunomodulatory disease. None of the patients developed a periprosthetic infection at a later stage.
CONCLUSION
With an incidence of 0.12%, it is rare to unexpectedly detect bacterial synovitis during surgery. Total synovectomy, use of bone cement with two antibiotics, and immediate systemic antibiotic therapy seem to keep the risk of periprosthetic infection low.
PubMed: 37508249
DOI: 10.3390/antibiotics12071153 -
JA Clinical Reports Dec 2023The upper cervical spine is a major focus of damage by rheumatoid arthritis (RA). Specific screening for mobility of the upper cervical spine, which is essential for...
BACKGROUND
The upper cervical spine is a major focus of damage by rheumatoid arthritis (RA). Specific screening for mobility of the upper cervical spine, which is essential for direct laryngoscopy, is lacking. Herein, we present a case of RA with Cormack-Lehane grade IV, which was not predicted by preoperative examination.
CASE PRESENTATION
A 66-year-old woman with RA was scheduled for a right total knee arthroplasty and right elbow synovectomy. She had a long history of RA without symptoms related to the cervical spine or spinal cord. Although physical examination suggested moderate risk of difficult intubation with preserved cervical retroflexion, her Cormack-Lehane classification was grade IV under muscle relaxation. Bony integration of the occiput to axis was considered to be the main cause of difficult direct laryngoscopy, and restricted neck rotation was found postoperatively.
CONCLUSIONS
RA patients may have limited upper cervical spine motion despite normal cervical retroflexion.
PubMed: 38051390
DOI: 10.1186/s40981-023-00679-9 -
Danish Medical Journal Aug 2023In the US, opioids are commonly prescribed after arthroscopic knee surgery. We aimed to investigate opioid dispensing in relation to arthroscopic knee surgeries from...
INTRODUCTION
In the US, opioids are commonly prescribed after arthroscopic knee surgery. We aimed to investigate opioid dispensing in relation to arthroscopic knee surgeries from 2006 to 2018 in Denmark.
METHODS
In Danish registries, we identified patients (≥ 15 years old) having arthroscopic knee surgery (anterior cruciate ligament (ACL) reconstruction; meniscal surgery; cartilage resection; synovectomy and diagnostic arthroscopy) between 1 January 2006 and 31 December 2018 and opioid dispensing (oral morphine equivalents (OMEQ)) within seven days after discharge from surgery.
RESULTS
Among 218,940 patients, 15,263 (7%) had an opioid dispensed within seven days after being discharged following surgery. The opioid dispensing incidence (per 1,000 persons/year) increased during the study period for all procedures. This trend was more pronounced for ACL reconstruction, which recorded an increase from 86 (95% confidence interval (CI): 75-99) in 2006 to 278 (95% CI: 255-301) in 2018, corresponding to 9% and 28% of ACL patients, respectively. In the same period, the average amount of opioids dispensed within the first seven days after discharge decreased (change: 70.0 OMEQ (95% CI: 12.4-127.5)). Tramadol and oxycodone were the most commonly dispensed opioids.
CONCLUSION
About 7% of patients had an opioid dispensed within the first seven days after discharge following arthroscopic knee surgery. The incidence of opioids dispensed increased for all investigated procedures from 2006 to 2018. In the same period, the average amount of opioids dispensed within the first seven days after discharge decreased.
FUNDING
None.
TRIAL REGISTRATION
Not relevant.
Topics: Humans; Adolescent; Analgesics, Opioid; Arthroscopy; Tramadol; Patient Discharge; Denmark
PubMed: 37622647
DOI: No ID Found -
International Journal of Surgery Case... Oct 2023Primary Synovial chondromatosis is a rare disease characterized by metaplastic cartilaginous nodules originating from the synovium, which rarely involves the ankle...
INTRODUCTION AND IMPORTANCE
Primary Synovial chondromatosis is a rare disease characterized by metaplastic cartilaginous nodules originating from the synovium, which rarely involves the ankle joint. To date, there has been a limited number of reported cases regarding the arthroscopic treatment of this disease, which can be attributed to its rare incidence. This article aims to illuminate the advantages and challenges of this technique by presenting a case study. Furthermore, we delve into the existing literature to assess the different treatments used for this disease and their outcomes.
CASE PRESENTATION
A 59-year-old male patient presented with ankle pain, swelling and limited dorsiflexion. Subsequent imaging findings led to the diagnosis of anterior ankle primary synovial chondromatosis. Following this, the patient underwent arthroscopic assisted loose body removal and partial anterior synovectomy, conducted via anteromedial and anterolateral portals. During the five-year follow-up period, no recurrence was observed, and the American Orthopedic Foot and Ankle Score (AOFAS) was assessed as 88.
CLINICAL DISCUSSION
Given the uncommon occurrence of this disease, no standardized treatment approach has been established in the literature. While many researchers advocate for surgical intervention to alleviate symptoms and prevent potential complications like osteoarthritis and malignancy, there exists a diversity of perspectives concerning the specific strategies and techniques to employ.
CONCLUSION
Partial anterior synovectomy and loose body removal using arthroscopy via anteromedial and anterolateral portals demonstrate a notably efficacious and low-risk technique for addressing primary synovial chondromatosis affecting the anterior chamber of the ankle.
PubMed: 37738829
DOI: 10.1016/j.ijscr.2023.108832 -
Cancers Jan 2024Tenosynovial giant cell tumor (TSGCT) is a rare soft tissue tumor that involves the synovial lining of joints, bursae, and tendon sheaths, primarily affecting young... (Review)
Review
Tenosynovial giant cell tumor (TSGCT) is a rare soft tissue tumor that involves the synovial lining of joints, bursae, and tendon sheaths, primarily affecting young patients (usually in the fourth decade of life). The tumor comprises two subtypes: the localized type (L-TSGCT) and the diffuse type (D-TSGCT). Although these subtypes share histological and genetic similarities, they present a different prognosis. D-TSGCT tends to exhibit local aggressiveness and a higher recurrence rate compared to L-TSGCT. Magnetic resonance imaging (MRI) is the preferred diagnostic tool for both the initial diagnosis and for treatment planning. When interpreting the initial MRI of a suspected TSGCT, it is essential to consider: (i) the characteristic findings of TSGCT-evident as low to intermediate signal intensity on both T1- and T2-weighted images, with a blooming artifact on gradient-echo sequences due to hemosiderin deposition; (ii) the possibility of D-TSGCT-extensive involvement of the synovial membrane with infiltrative margin; and (iii) the resectability and extent-if resectable, synovectomy is performed; if not, a novel systemic therapy involving colony-stimulating factor 1 receptor inhibitors is administered. In the interpretation of follow-up MRIs of D-TSGCTs after treatment, it is crucial to consider both tumor recurrence and potential complications such as osteoarthritis after surgery as well as the treatment response after systemic treatment. Given its prevalence in young adult patents and significant impact on patients' quality of life, clinical trials exploring new agents targeting D-TSGCT are currently underway. Consequently, understanding the characteristic MRI findings of D-TSGCT before and after treatment is imperative.
PubMed: 38254890
DOI: 10.3390/cancers16020402 -
Cureus Sep 2023Acute carpal tunnel syndrome (ACTS) is an urgent condition in which symptoms progress rapidly on an hourly basis, and emergency surgery may be required to treat it. ACTS...
Acute carpal tunnel syndrome (ACTS) is an urgent condition in which symptoms progress rapidly on an hourly basis, and emergency surgery may be required to treat it. ACTS often occurs after a traumatic event such as a fracture of the distal radius, and rarely occurs non-traumatically. We present a case of a 60-year-old male with ACTS secondary to acute synovitis due to rheumatoid arthritis. The patient complained of strong numbness from the thumb to the ring finger and pain in the palm, and he was unable to actively flex or extend his fingers. In addition, severe tenderness was observed in the palm; on the contralateral side, no obvious tenderness of the forearm and wrist joint was observed. Due to the intolerable pain and numbness, ACTS was suspected. Internal pressure from the forearm to the palm was measured, and it was found that the internal pressure of the carpal tunnel was elevated at 150 mmHg. Based on these findings, non-traumatic ACTS was diagnosed, and emergency surgery was performed. The transverse carpal ligament was exposed, an incision was made from the distal end, and the proximal part was fully incised to the forearm fascia so that the carpal tunnel was completely released. The synovial membranes around the median nerve were peeled off, confirming that the nerve had been loosened sufficiently. After the operation, finger pain and numbness improved dramatically from the day after surgery. Proper diagnosis and prompt treatment with surgical median nerve decompression are crucial for good functional recovery in these patients.
PubMed: 37818512
DOI: 10.7759/cureus.44935 -
Journal of Orthopaedic Case Reports Aug 2023Synovial chondromatosis is a rare non- malignant bone tumor. Most commonly middle aged people are affected . This condition most commonly occurs in knee joints, and...
INTRODUCTION
Synovial chondromatosis is a rare non- malignant bone tumor. Most commonly middle aged people are affected . This condition most commonly occurs in knee joints, and rarely, it may occur in other joints. Patient usually complaints of pain, swelling and restrictions of movements at the affected joint. Diagnosis is made through thorough clinical examination and Radiological investigation. Condition is treated with open synovectomy with the removal of loose bodies. If not treated in time the patient might develop early osteoarthritic changes and rarely develop into malignancy in few cases.
CASE REPORT
A 43 year old female came with complaints of pain and stiffness over the right elbow which aggravates on movements without alleged history of trauma. The patient was diagnosed with synovial chondromatosis after appropriate radiological investigation. The patient underwent open synovectomy and post operatively adequate physiotherapy was initiated at the operated elbow. After 6 months of follow-up, the patient improved clinically and functionally.
CONCLUSION
Synovial chondromatosis of the elbow is a rare benign orthopedic condition that appears as multiple hyaline cartilage nodules within sub synovial connective tissue. Complete excision of synovium is necessary to prevent the recurrence and for better clinical outcome.
PubMed: 37654745
DOI: 10.13107/jocr.2023.v13.i08.3802 -
Journal of ISAKOS : Joint Disorders &... Dec 2023Approach to the posterior compartment of the knee joint and working within it has been made assessable since the trans-septal approach was established. Herein, the...
Approach to the posterior compartment of the knee joint and working within it has been made assessable since the trans-septal approach was established. Herein, the authors describe a simple intercruciate trans-septal approach to the posterior compartment of the knee joint. This technique allows a direct visualization to the posterior septum (septum), creating a safer trans-septal portal and easier separation of the septum. The authors have used this approach in conditions such as the posterior cruciate ligament (PCL) reconstruction, PCL avulsion repairs, popliteus tendon reconstruction, posterior compartment synovectomy, hardware removal, loose bodies removal, meniscus ramp lesion repair, and others. No complications such as femoral condyle damage, meniscus damage, or neurovascular bundle injuries has occurred with this approach.
Topics: Humans; Arthroscopy; Knee Joint; Tendons; Joint Loose Bodies; Plastic Surgery Procedures
PubMed: 37481131
DOI: 10.1016/j.jisako.2023.07.004 -
Journal of Orthopaedic Case Reports Aug 2023The elbow pain and restricted movement is a nagging problem and elbow arthropathies need to be excluded. On rare instances, uncommon etiology like a benign lesion is the...
INTRODUCTION
The elbow pain and restricted movement is a nagging problem and elbow arthropathies need to be excluded. On rare instances, uncommon etiology like a benign lesion is the culprit and the diagnosis would require judicious clinicoradiological correlation. Osteoid osteoma in the intra- or juxta-articular region is reported in the literature as rare, sporadic report.
CASE REPORT
A 23-year-old, Indian male patient presented with a provisional diagnosis of early elbow arthropathy on account of unexplained pain and restricted elbow movement without a history of trauma. He was subjected to appropriate investigations revealing synovial hypertrophy, effusion, and bone edema suggestive of early arthropathy. Additional imaging led to an uncommon definitive diagnosis. An intra-articular osteoid osteoma was found over the medial aspect of the coronoid fossa with a thin rim of cortical rim projecting anteriorly. The lesion was diagnosed and delineated on computerized tomography and an open excision of the lesion and synovectomy was done for histopathological evaluation. Histology confirmed the presence of an osteoid osteoma at an uncommon location.
CONCLUSION
The careful appreciation of radiological images is critical to not miss significant etiology that may mimic non-specific elbow pain. High index of suspicion coupled with appropriate diagnostic imaging results in early diagnosis and appropriate management. Osteoid osteoma should be a differential diagnosis in cases with pain and restricted elbow movement and excision of which results in recovery of painless range of motion.
PubMed: 37654760
DOI: 10.13107/jocr.2023.v13.i08.3842 -
Journal of Orthopaedic Surgery (Hong... 2023Arthroscopic resection of tenosynovial giant cell tumor (TS-GCT) presents favorable outcomes. However, there are reportedly higher recurrence rates in patients who had...
BACKGROUND
Arthroscopic resection of tenosynovial giant cell tumor (TS-GCT) presents favorable outcomes. However, there are reportedly higher recurrence rates in patients who had incomplete resection. To minimize incomplete resection, we established a multiple portal approach depending on the location of the disease. In this study, we aimed to retrospectively evaluate the clinical outcomes of arthroscopic resection for both localized and diffuse types of TS-GCT of the knee.
METHODS
From 2009 to 2019, 13 patients who underwent arthroscopic synovectomy of the knee and were histologically diagnosed with TS-GCT were included in this study. The pre- and postoperative range of motion (ROM) of the knee was measured. The Japanese Orthopaedic Association (JOA) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were assessed at the final follow-up examination. Magnetic resonance imaging was performed to detect incomplete resection or local recurrence.
RESULTS
Among the 13 patients, seven and six had localized and diffuse type TS-GCT, respectively. Regarding the knee ROM, preoperative knee flexion in patients with the localized type was limited compared with that in those with the diffuse type. However, the ROM was significantly improved in patients with both types postoperatively. The JOA score and KOOS of patients with both types at the final follow-up were favorable, and there were no significant differences between both types. There was neither recurrence nor incomplete resection in any patient for both types.
CONCLUSION
All patients, regardless of the TS-GCT type, achieved favorable outcomes after arthroscopic surgery; especially, the failure rate was 0%.
Topics: Humans; Synovitis, Pigmented Villonodular; Retrospective Studies; Synovectomy; Giant Cell Tumor of Tendon Sheath; Knee Joint; Arthroscopy
PubMed: 38051283
DOI: 10.1177/10225536231220413