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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 -
The Journal of Hand Surgery Jun 2023Elbow arthritis is an uncommon condition that can cause debilitating pain, stiffness, or instability. The most common etiologies include rheumatoid arthritis,... (Review)
Review
Elbow arthritis is an uncommon condition that can cause debilitating pain, stiffness, or instability. The most common etiologies include rheumatoid arthritis, posttraumatic arthritis, and primary osteoarthritis. Treatment begins with nonsurgical modalities, including activity modification, anti-inflammatories, hand therapy, and corticosteroids. Operative intervention may be considered once nonsurgical management has failed. Surgical treatment depends on the underlying etiology, chief complaint, patient age, and functional demand. Advances in technology, especially arthroscopic techniques, have expanded the treatment options available to surgeons. The goals of treatment include pain relief and restoration of functional range of motion. The purpose of this article is to review the pertinent soft tissue and osseous anatomy, discuss the etiologies, review the principles of diagnosis and evaluation, and finally, study the treatment options for elbow arthritis.
Topics: Humans; Elbow; Elbow Joint; Arthroscopy; Arthritis, Rheumatoid; Range of Motion, Articular; Treatment Outcome
PubMed: 36759236
DOI: 10.1016/j.jhsa.2022.12.014 -
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 -
Inflammopharmacology Feb 2024Crude forms of musculoskeletal surgery have been performed through history for the treatment of deformity, pain and the horrors of battle. In more modern times Muller is...
Crude forms of musculoskeletal surgery have been performed through history for the treatment of deformity, pain and the horrors of battle. In more modern times Muller is credited with the first synovectomy in rheumatoid arthritis in 1884, and a Synovectomy was first performed by Richard von Volkmann (1830-1889) for joint tuberculosis. Chemical synovectomy consisting of the intra-articular injection of various agents was popular for a while but is now largely discarded. Joint resection for sepsis and tuberculosis has been documented since the early 1800s, and also joint arthrodesis, and osteotomy. Modern arthroscopic techniques have added the utility of faster intra-joint inspection and treatment while reduced surgical time exposure and often applied with the use of limb regional anaesthetic nerve blocks, to avoid general anaesthetic. Joint arthroplasty has been developed since1800s, with the use of many artificial joint components. There have been many notable pioneers of this work who are documented in this text, among them Austin T. Moore (1899-1963), George McKee (1906-1991) and Sir John Charnley (1911-1982). The success of joint arthroplasty to the hip, knee, shoulder and other joints has resulted in life-changing benefit for hundreds of arthritis and injury sufferers.
Topics: Humans; Arthritis, Rheumatoid; Injections, Intra-Articular; Knee Joint; Pain; Sepsis
PubMed: 37195498
DOI: 10.1007/s10787-023-01224-x -
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 -
Revue Medicale de Liege Oct 2023Synovial chondromatosis is a rare pathology that involves most frequently the weight-bearing joints. It is due to the development of cartilaginous bodies from the...
Synovial chondromatosis is a rare pathology that involves most frequently the weight-bearing joints. It is due to the development of cartilaginous bodies from the synovial membrane that could migrate threw the joint. Primary and secondary forms exist. Clinical examination will be marked by swellings and loss of mobility. Cross-sectional imaging has the preference. The treatment of choice is the removal of cartilaginous loose bodies with or without a synovectomy.
Topics: Humans; Chondromatosis, Synovial; Synovectomy; Joint Loose Bodies
PubMed: 37830315
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 -
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 -
Archives of Orthopaedic and Trauma... Nov 2020Although metallosis is a well-known complication after total hip arthroplasty, little is known about this phenomenon after total (TKA) or unicompartmental knee... (Review)
Review
INTRODUCTION
Although metallosis is a well-known complication after total hip arthroplasty, little is known about this phenomenon after total (TKA) or unicompartmental knee arthroplasty (UKA). The aim of the present work was to review the current knowledge about the reasons and the diagnostic as well as therapeutic management of metallosis after knee arthroplasty.
MATERIALS AND METHODS
A literature search was performed through PubMed until April 2019. Search terms were "metallosis" in combination with "knee", "knee prosthesis", "knee arthroplasty" and "knee replacement", respectively. All publications were analyzed regarding publication year, level of evidence, number of knees/patients treated, type of prosthesis, metallosis cause, time period between primary implantation and metallosis emergence, laboratory examination, treatment, complications and follow up.
RESULTS
A total of 38 studies reporting on a total of 97 knees were identified. 29 studies reported on metallosis after TKA, 8 after UKA, and one study after both procedures. The time period between the primary implantation and metallosis emergence ranged between 6 weeks and 26 years. The most common reason was the failure of a metal-backed patellar component in 40%, followed by implant/structural- and PE failure (wear/dislocation) in 27% and 18% of the cases, respectively. Complete blood cell count, serum chemistry, erythrocyte sedimentation rate or C-reactive protein serum values were not indicative to diagnose metallosis. The diagnosis was confirmed by histopathological analyses and macroscopic evaluation during surgery. Depending on the particular cause various surgical procedures have been performed. Complete prosthesis exchange was the most common one showing no complications in 89.4% of the cases.
CONCLUSIONS
Metallosis after knee arthroplasty is a rare and perhaps underestimated or under published complication. A systematic diagnostic approach is necessary for the timely and correct diagnosis. A thorough debridement as well as a (sub)total synovectomy should be always performed. In cases with a damaged component, a partial/complete prosthesis exchange leads to the best results. Should a malalignment be the cause of the metallosis, then it should be corrected within the revision surgery.
Topics: Arthroplasty, Replacement, Knee; Humans; Metals; Postoperative Complications; Reoperation
PubMed: 32715399
DOI: 10.1007/s00402-020-03560-x