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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 -
Nederlands Tijdschrift Voor Geneeskunde Jan 2022Arthroscopy of the wrist has gained popularity among hand and wrist surgeons for diagnosing and treating wrist pathologies. In general, it is a minimally-invasive...
Arthroscopy of the wrist has gained popularity among hand and wrist surgeons for diagnosing and treating wrist pathologies. In general, it is a minimally-invasive procedure which can be performed in day care surgery. It has a higher diagnostic accuracy compared to conventional imaging modalities such as CT or MRI. Simultaneous therapeutic intervention can be performed such as ligament repair, fracture reduction, ganglion cyst removal or synovectomy of the wrist. Recent studies have shown better functional outcomes and fewer complications compared to open surgical interventions. Prospective studies are still needed to confirm effectiveness and safety of wrist arthroscopy for several indications. Nonetheless, wrist arthroscopy has shown to be an important asset in the repertoire of the hand and wrist surgeon.
Topics: Arthroscopy; Humans; Magnetic Resonance Imaging; Wrist; Wrist Injuries; Wrist Joint
PubMed: 35138709
DOI: No ID Found -
Orthopedics 2021Synovial chondromatosis of the finger is a rare metaplasia affecting either the finger joint or the tendon sheath. It is a benign extraosseus cartilage tumor that often... (Review)
Review
Synovial chondromatosis of the finger is a rare metaplasia affecting either the finger joint or the tendon sheath. It is a benign extraosseus cartilage tumor that often occurs in numbers and is not solitary in nature. This accumulation of masses within the finger can lead the patient to seek medical care. Symptoms are often painful and functionally disabling. Although rare, synovial chondromatosis must be considered in the differential diagnosis for patients with multiple lesions or masses within the hand and finger. Patient workup involves advanced imaging, including magnetic resonance imaging, ultrasonography, and computerized tomography. However, the results of these studies may be inconclusive. Conservative management can be discussed with the patient but has proven to be ineffective. Surgical excision is the recommended first-line treatment. Whether the surgery is arthroscopic or open, with or without synovectomy, is at the surgeon's discretion. Mass recurrence after surgery is an unfortunate complication, and subsequent treatment strategies are undefined. Recurrence may not occur at the same anatomical site. This condition can be intra-articular (within the figure joint) or extra-articular (within the tendon sheath or bursa). Revision surgery in the form of open excision with synovectomy is the mainstay of treatment. There have been only a few case reports of synovial chondromatosis involving the finger. This case series and up-to-date review of the literature presents a discussion of current surgical care. [. 2021;44(3):e454-e457.].
Topics: Chondromatosis, Synovial; Fingers; Humans; Recurrence; Synovectomy
PubMed: 33561871
DOI: 10.3928/01477447-20210201-05 -
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 -
Current Opinion in Pediatrics Feb 2024Pigmented villonodular synovitis (PVNS) is a rare diagnosis in pediatric patients and commonly presents with symptoms of swelling and pain. Early diagnosis is important... (Review)
Review
PURPOSE OF REVIEW
Pigmented villonodular synovitis (PVNS) is a rare diagnosis in pediatric patients and commonly presents with symptoms of swelling and pain. Early diagnosis is important to prevent secondary degeneration into the subchondral bone. This review will analyze the etiology, clinical signs/symptoms, diagnosis, treatment, and recent literature on PVNS in the pediatric population.
RECENT FINDINGS
Many theories of PVNS etiology have been described in the literature; however, an inflammatory response has been most widely accepted. PVNS can occur in any joint, but most commonly in the knee. The most common treatment for PVNS is synovectomy, and long-term follow-up is necessary to detect disease persistence or recurrence.
SUMMARY
Although uncommon, PVNS does occur in the pediatric population and this diagnosis should be included in the differential of atraumatic joint swelling and pain.
Topics: Humans; Child; Synovitis, Pigmented Villonodular; Knee Joint; Giant Cell Tumors; Synovectomy; Pain
PubMed: 37994651
DOI: 10.1097/MOP.0000000000001312 -
The Journal of the American Academy of... Dec 2019Arthritis of the thumb metacarpophalangeal joint can be debilitating whether in isolation or in conjunction with degenerative disease at the adjacent joints. Despite its... (Review)
Review
Arthritis of the thumb metacarpophalangeal joint can be debilitating whether in isolation or in conjunction with degenerative disease at the adjacent joints. Despite its crucial role in fluid and dexterous motion of the thumb axis, little is known about the isolated incidence of pathology at this joint. Etiologies include primary, posttraumatic, and inflammatory arthritis. For early, isolated degenerative disease, arthroscopic synovectomy has been shown to yield satisfactory results. For more advanced disease, fusion is the benchmark. The literature suggests that increased flexion angles may mitigate development of trapeziometacarpal arthritis. In case of advanced arthropathy of the entire thumb axis, arthroplasty is a viable option to reduce pain, preserve motion, and thus limit progression of adjacent joint disease. Special considerations should be given to the rheumatoid thumb because a select combination of treatments for each deformity is thought to best address the unique pathomechanics.
Topics: Arthritis; Arthrodesis; Arthroplasty; Arthroscopy; Humans; Metacarpophalangeal Joint; Thumb
PubMed: 31356425
DOI: 10.5435/JAAOS-D-18-00683 -
EFORT Open Reviews Jun 2020Musculo-skeletal complications of the hand in the haemophilia patient are rare, and they include synovitis, arthropathy, pseudotumours, carpal tunnel syndrome and... (Review)
Review
Musculo-skeletal complications of the hand in the haemophilia patient are rare, and they include synovitis, arthropathy, pseudotumours, carpal tunnel syndrome and vascular aneurysms and pseudoaneurysms.The best way to prevent the aforementioned musculo-skeletal complications is early continuous haematological primary prophylaxis (intravenous infusion of the deficient coagulation factor, ideally from cradle to death).There is a wide range of procedures that a hand surgeon treating these patients should be able to manage, including synovectomy, prosthetic replacement of small joints, removal or curettage of pseudotumours, release of carpal tunnel and, occasionally, vascular reconstruction of aneurysms.The treatment of these patients should be made at an institution with close collaboration between haematologists and hand surgeons (all surgical procedures must always be performed under cover of the deficient coagulation factor). Cite this article: 2020;5:328-333. DOI: 10.1302/2058-5241.5.190078.
PubMed: 32655887
DOI: 10.1302/2058-5241.5.190078 -
Haemophilia : the Official Journal of... Mar 2024People with haemophilia (PWH) not administered primary haematological prophylaxis since childhood, that is, those treated haematologically on demand or not treated at... (Review)
Review
INTRODUCTION
People with haemophilia (PWH) not administered primary haematological prophylaxis since childhood, that is, those treated haematologically on demand or not treated at all, often experience the degeneration of the ankles, leading to pain and functional impairment.
AIM
To analyse the outcomes and complications of arthroscopic ankle surgery performed on PWH.
METHODS
For this narrative review of the literature, a search was conducted in PubMed on 2, December 2023, using the keywords "haemophilia", "ankle" and "arthroscopy". Of the 29 articles identified, 15 specifically related to ankle arthroscopy in PWH were selected (inclusion criterion). The remaining articles did not meet this requirement (exclusion criterion) and were therefore eliminated.
RESULTS
Arthroscopic procedures (arthroscopic synovectomy, debridement and arthrodesis of the ankle) are increasingly used in the surgical treatment of haemophilic ankle arthropathy. Although arthroscopic ankle surgery offers good outcomes in patients with haemophilia, the procedure is not free of complications, which range from 7.9% for arthroscopic ankle debridement to 13.1% in arthroscopic ankle synovectomy and 17.8% in arthroscopic ankle arthrodesis, respectively. The non-union rate of arthroscopic ankle arthrodesis is 7.1% (2/28).
CONCLUSION
Although arthroscopic interventions in the haemophilic ankle (synovectomy, debridement, arthrodesis) offer good functional outcomes, they are associated with a non-negligible rate of complications. Arthroscopic ankle surgery in PWH is major surgery and should be treated as such.
Topics: Humans; Child; Hemophilia A; Ankle; Hemarthrosis; Arthroscopy; Ankle Joint; Arthritis; Arthrodesis; Treatment Outcome
PubMed: 38379188
DOI: 10.1111/hae.14967 -
Journal of Orthopaedic Surgery and... Mar 2022Lipoma arborescens (LA) is a rare benign synovial tumour characterized by the proliferation of mature adipocytes within the synovial cells. Given its rarity, current... (Review)
Review
BACKGROUND
Lipoma arborescens (LA) is a rare benign synovial tumour characterized by the proliferation of mature adipocytes within the synovial cells. Given its rarity, current evidence is mainly based on case reports and case series, and no guidelines are available. The present study investigated the current surgical management and related outcomes of LA in the upper limb.
METHODS
This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library were accessed in September 2021. Clinical studies evaluating patients with LA undergoing surgical treatment were considered eligible for this systematic review. Only studies which reported data on LA located in the upper limb with histopathological confirmation were considered. Articles that reported data from nonsurgical management were not considered.
RESULTS
A total of 21 studies reporting 22 lesions in 21 patients were assessed. The mean age of the patients was 48.48 years (range 22-77). Most studies evaluated the restoration of range of motion and symptom resolution for the functional outcome assessment. Open or arthroscopic excision and synovectomy were the most common surgical procedures for LA. The concomitant lesions were treated in a single-stage procedure. All patients had satisfactory outcomes after open or arthroscopic excision and synovectomy without recurrence at a mean follow-up of 21.14 months (range 2-60). One patient developed postoperative cellulitis (4.55%).
CONCLUSION
Open and arthroscopic excision combined with synovectomy should be considered the standard treatment option of upper limb LA. Concomitant pathologies can be addressed in a one-stage procedure. Although LA was recognized as a clinical entity decades ago, there is a lack of evidence based guidelines and long term outcome data are unavailable.
Topics: Adult; Aged; Arthroscopy; Humans; Knee Joint; Lipoma; Middle Aged; Soft Tissue Neoplasms; Synovectomy; Synovial Membrane; Treatment Outcome; Young Adult
PubMed: 35246183
DOI: 10.1186/s13018-022-02997-7 -
Arthroscopy Techniques Feb 2022Surgical treatment has been recommended as the first choice of therapy in second and third stages of the disease. Complete synovectomy and removal of all loose bodies is...
Surgical treatment has been recommended as the first choice of therapy in second and third stages of the disease. Complete synovectomy and removal of all loose bodies is advisable for prevention of recurrence of the disease. Recently, arthroscopic treatment of synovial chondromatosis is gaining popularity because of its favorable outcomes and very low complication and recurrence rates. Arthroscopic approach also allows management of concomitant pathology. The purpose of this Technical Note is to describe the technique of arthroscopic synovectomy and removal of loose bodies as treatment of synovial chondromatosis localized in the anterior compartment of the ankle joint.
PubMed: 35155111
DOI: 10.1016/j.eats.2021.10.002