-
Journal of Clinical Orthopaedics and... Sep 2023Osteoarticular Tuberculosis (TB) of wrist joint is a rare, often misdiagnosed form of site affected by infection that can lead to severe disability and morbidity. This... (Review)
Review
BACKGROUND
Osteoarticular Tuberculosis (TB) of wrist joint is a rare, often misdiagnosed form of site affected by infection that can lead to severe disability and morbidity. This review aims to summarize the current literature on the diagnosis and management of infection of the wrist joint.
MATERIALS AND METHODS
A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted on PubMed, Google Scholar, and Web of Science databases from 1967 to 2022, excluding single case reports and correspondence articles. The keywords used for the search included ' 'osteoarticular' and 'wrist'. Clinical presentation, demographic details, complementary investigations undertaken, trends, and complications of different management interventions were recorded to generate this review.
RESULTS
Osteoarticular Tuberculosis (TB) of the wrist joint accounts for fewer than 1% of all skeletal TB cases across a spectrum of age ranges. Magnetic Resonance Imaging (MRI) represents an excellent modality to reveal the extent of the disease at an early stage of the condition. Synovial fluid analysis has been recommended for microbiological diagnosis. Treatment options include anti-tubercular therapy (ATT), incision and drainage, debridement, synovectomy, and arthrodesis.
CONCLUSION
Early diagnosis and treatment of wrist tuberculosis is crucial for achieving good functional outcomes in patients with this uncommon condition. Polymerase Chain Reaction (PCR) and GeneXpert technology for the detection of (MTB) have improved diagnostic accuracy in detecting MTB DNA and rifampicin resistance. Anti-Tubercular Therapy (ATT) regime remains a foundation pillar in the overall management of these patients with focused surgical interventions leading to improved clinical outcomes.
PubMed: 37841656
DOI: 10.1016/j.jcot.2023.102257 -
Journal of Hand and Microsurgery Sep 2023Since 1958, more than 50 postresidency fellowship programs in hand surgery have been introduced within the United States. Ongoing changes in health care and medical...
Since 1958, more than 50 postresidency fellowship programs in hand surgery have been introduced within the United States. Ongoing changes in health care and medical education necessitate the evaluation of these fellowships. The purpose of this study is to identify trends in operative experience over time regarding procedure volume, surgery type, and anatomic region. National Accreditation Council for Graduate Medical Education (ACGME) case logs of graduating orthopaedic hand surgery fellows were evaluated for years 2011 to 2019. Procedures were grouped according to ACGME-defined categories for hand surgery. The mean number of procedures per fellow in each category was trended over time using a Mann-Kendall test. All 1,257 fellows were included. The mean number of procedures completed annually by each fellow increased from 797.6 in 2011 to 945.6 in 2019 ( < 0.01). Over the course of the study period, there were increases in the number of "soft tissue," "fracture," and "nerve" procedures ( < 0.001), while the number of "congenital" procedures decreased ( < 0.05). Additionally, small but statistically significant increases were found in "amputation," "Dupuytren's," and "decompression of tendon sheath/synovectomy/ganglions" procedures ( 0.01). There has been an increase in the number of procedures performed by orthopaedic hand surgery fellows over the past decade. This appears to be due to the increase in nerve, fracture, and soft tissue categories, and there has been a decrease in the number of congenital cases completed. These data confirm that the operative experiences for most hand surgery fellows are robust and growing over time.
PubMed: 37701317
DOI: 10.1055/s-0042-1742457 -
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 -
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 -
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 -
Arthroscopy : the Journal of... Apr 2022Glenohumeral arthritis is a challenging problem, especially in the young, active patient. After nonoperative treatment, including activity modification,...
Glenohumeral arthritis is a challenging problem, especially in the young, active patient. After nonoperative treatment, including activity modification, anti-inflammatory medications, physical therapy, and injections, is exhausted, surgical treatment ranging from simple debridement to arthroplasty is commonly offered. Given concerns regarding arthroplasty implant longevity, there is an interest in joint-preserving procedures. In this difficult population, the authors recommend a systematic, inclusive approach to the array of pathologies encountered in the setting of early glenohumeral arthritis: the Comprehensive Arthroscopic Management (CAM) procedure. CAM consists of the combination of arthroscopy, glenohumeral chondroplasty, synovectomy, loose body removal, microfracture, capsular release, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, and biceps tenodesis. Key perioperative care includes the use of regional nerve blocks to allow immediate physical therapy with the goal of restoring range of motion by 4 to 6 weeks with strengthening beginning at 6 to 12 weeks and return to full activities at 4 to 6 months. Although this is still considered a bridging procedure, the literature has reported 92% survival at 1 year, 85% survival at 2 years, 77% survival at 5 years, and 63% survival at 10 years. Predictors of failure of the CAM procedure include joint space <2 mm, flattening of the humeral head, and abnormal posterior glenoid morphology. Patient selection and education is therefore essential for optimizing outcomes.
Topics: Humans; Humeral Head; Osteoarthritis; Shoulder; Shoulder Joint; Treatment Outcome
PubMed: 35369910
DOI: 10.1016/j.arthro.2022.01.033 -
The Quarterly Journal of Nuclear... Dec 2022Radiosynoviorthesis (RSO) or radiation synovectomy has been practiced for more than half a century, but in many parts of the world, it is still relatively unknown and... (Review)
Review
Radiosynoviorthesis (RSO) or radiation synovectomy has been practiced for more than half a century, but in many parts of the world, it is still relatively unknown and not used to its full potential in the standard care for chronic, persistent or recurrent synovitis. The working mechanism of RSO is simple yet elegant. Radiopharmaceutical particles are, after injection in the affected synovial joint, gobbled up by phagocytizing subsynovial inflammatory cells. As a consequence, the synovium will be irradiated locally resulting in synovial cell necrosis and inhibition of cell proliferation, which eventually leads to a decrease in the inflammatory response in the joint cavity. In this review RSO is once again brought to the attention and common indications for RSO are discussed. Also, appropriate activities of the administrated radiopharmaceuticals and coadministrated glucocorticoids are provided. Furthermore, a detailed database-assisted chronological overview of published literature of RSO in inflammatory and non-inflammatory diseases, like rheumatoid arthritis, psoriatic arthritis, osteoarthritis and osteochrondomatosis, hemophilic hemarthrosis and pigmented villonodular synovitis (PVNS) is provided. Based upon the published literature an indication of level of evidence of RSO is discussed. There is evidence that RSO is effective in persistent synovitis in patients with a variety of causes for synovitis, although the effectiveness seems to decrease over time. In these patients, RSO may not be used to its full potential in many parts of the world. Results in of RSO in hemophilia patients with hemarthrosis are favourable, however the evidence for the effectiveness of RSO in these patients is less firm and mainly based on case series. The evidence for the efficacy of RSO as adjuvant therapy in PVNS is, at best, of very low quality.
Topics: Humans; Hemarthrosis; Synovitis, Pigmented Villonodular; Synovitis; Arthritis, Rheumatoid; Radiopharmaceuticals
PubMed: 35708601
DOI: 10.23736/S1824-4785.22.03470-7 -
Arthroscopy Techniques Dec 2021Knee osteoarthritis is the most common orthopaedic disorder, and surgical treatments are always inevitable. Among the various surgical options, arthroscopic treatment is...
Knee osteoarthritis is the most common orthopaedic disorder, and surgical treatments are always inevitable. Among the various surgical options, arthroscopic treatment is not favorable because strong evidence supporting its application is scarce. However, we consider that the unsatisfactory clinical results of arthroscopic surgery occur because the pain-relieving mechanism of joint replacement is not realized in the too simple and not well-designed arthroscopic procedures. Thus, we use a set of arthroscopic procedures to realize the pain-relieving mechanism of joint replacement, which we call "arthroscopic arthroplasty." The most important parts of this technique are denervation of the subchondral bone and comprehensive synovectomy. Our clinical results indicate that we can obtain even better functional improvement with this technique than that with joint replacement. We consider that the introduction of this technique will arouse interest in the development of arthroscopic surgical procedures for knee osteoarthritis.
PubMed: 35004145
DOI: 10.1016/j.eats.2021.08.008 -
The Journal of Hand Surgery, European... Feb 2024Wrist arthroscopy is a valuable and widely utilized tool in the treatment of triangular fibrocartilage complex (TFCC) injuries. These procedures include synovectomy... (Review)
Review
Wrist arthroscopy is a valuable and widely utilized tool in the treatment of triangular fibrocartilage complex (TFCC) injuries. These procedures include synovectomy alone, peri-capsular or transosseous repair, and arthroscopic-assisted reconstruction, and each are associated with specific complications. This review describes the types of complications and their rates in different types of arthroscopic TFCC surgery reported in the literature and in our centre. Across the spectrum of arthroscopic TFCC surgery, complication rates and the learning curve increase with surgical complexity. Relevant anatomy, prevention and management of complications including nerve injury and irritation, extensor tendon injury and tendinitis, fracture, stiffness, and persistence of symptoms or instability are discussed. Vigilance to anatomical details and careful dissection can help to reduce complications that may result in disturbing pain and functional loss.
Topics: Humans; Triangular Fibrocartilage; Arthroscopy; Wrist Injuries; Wrist Joint; Tendon Injuries
PubMed: 38315134
DOI: 10.1177/17531934231218608 -
Orthopaedics & Traumatology, Surgery &... Sep 2023Pigmented villonodular synovitis (PVNS) is a rare pathology of the elbow, but presents a risk of progression with cartilage destruction. Surgical treatment consists in...
INTRODUCTION
Pigmented villonodular synovitis (PVNS) is a rare pathology of the elbow, but presents a risk of progression with cartilage destruction. Surgical treatment consists in synovectomy, as complete as possible. Arthroscopy is an excellent tool for the exploration and treatment of intra-articular lesions in the elbow, but the results in PVNS of the elbow have never been evaluated. The aim of this study was to assess the recurrence rate of PVNS of the elbow after arthroscopic synovectomy, and secondarily to assess pain, joint range of motion, functional scores and complication rate.
MATERIAL AND METHODS
We performed a retrospective study of a continuous series of 8 patients operated on between February 2012 and February 2019, with a mean age of 43.7 years. The operated side was the dominant side in 75% of cases. Surgery consisted in the most complete synovectomy possible, performed arthroscopically. Recurrence, clinical evaluation, with pain at rest and on mpvement on visual analogue scale (VAS) and joint range of motion, functional MEPS and DASH scores, and any complications were collected.
RESULTS
At a mean 66.4 months' follow-up, 2 patients required revision surgery for recurrence. At the last follow-up, VAS for pain at rest was 0.9 and 1.9 for pain on movement. MEPS score was 85.6 and DASH score 82.2. No neurological, vascular or infectious complications of arthroscopic synovectomy were found in our series.
DISCUSSION
Arthroscopic synovectomy in the treatment of PVNS of the elbow was a reliable and safe therapeutic alternative, with a low complications rate and 2 cases of recurrence (25%) in our study. This was the first study to report the results of arthroscopic surgical treatment of elbow PVNS.
LEVEL OF EVIDENCE
IV Retrospective study without control group.
Topics: Humans; Adult; Synovitis, Pigmented Villonodular; Elbow; Treatment Outcome; Retrospective Studies; Knee Joint; Synovectomy; Pain; Arthroscopy
PubMed: 36455866
DOI: 10.1016/j.otsr.2022.103493