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International Journal of Surgery... Mar 2022Rheumatoid arthritis commonly causes transient limitation of joint motion, but the treatment of persistent stiffness in the rheumatoid elbow has rarely been reported....
BACKGROUND
Rheumatoid arthritis commonly causes transient limitation of joint motion, but the treatment of persistent stiffness in the rheumatoid elbow has rarely been reported. The purpose of this study was to evaluate the long-term clinical results of surgical treatment of rheumatoid elbow stiffness.
METHODS
Surgical treatment, including open arthrolysis with hinged external fixation, total synovectomy, and ulnar nerve release and anteriorization, was performed in 48 elbows in 43 patients with rheumatoid arthritis and early joint destruction. Mobility (flexion-extension and pronation-supination), Mayo Elbow Performance Score (MEPS), visual analog scale (VAS) score, muscle strength, nerve symptoms, postoperative complications, and recurrent synovitis were evaluated 9-11 years (average, 9.88 years) postoperatively.
RESULTS
The mobility of the elbow was significantly improved over the preoperative period either in extension, flexion, protonation, supination (P < .001, P < .001, P < .001, P = .002). The mean MEPS was significantly improved from 56.25 points (range, 30-90) to 87.40 points (range, 40-100) (P < .001). The pain was relieved, and the mean VAS score was reduced from 3.56 (range, 0-8) to 1.08 (range, 0-5) points (P < .001). Preoperative ulnar nerve symptoms were observed in 17 patients and relieved in 10 (59%) patients, and the mean Amadio score was raised from 6.9 (range, 3-9) to 7.96 (range, 4-9) points (P < .001). Through surgical treatment and postoperative rehabilitation, the mean grip strength of the patients was significantly improved from an average of 9.01 (range, 3.4-18.5) to 17.56 kg (range, 3.9-40.2) (P < .001). Five elbows developed recurrent synovitis, and one underwent total elbow arthroplasty. Postoperative complications were uncommon and not severe.
CONCLUSION
Surgical treatment is a reliable procedure for rheumatoid elbow stiffness and can be effective in improving elbow mobility, function, muscle strength, pain relief, and relief of nerve symptoms.
Topics: Arthritis, Rheumatoid; Elbow; Elbow Joint; Follow-Up Studies; Fracture Fixation; Humans; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 35259520
DOI: 10.1016/j.ijsu.2022.106590 -
Frontiers in Immunology 2022Lyme disease is caused by , and the pathogenesis of the disease is complex with both bacterial and host factors contributing to inflammatory responses. Lyme disease...
Lyme disease is caused by , and the pathogenesis of the disease is complex with both bacterial and host factors contributing to inflammatory responses. Lyme disease affects different organs including joints and results in arthritis. Immune responses stimulated by through toll-like receptors cause infiltration of leukocytes, which produce inflammatory cytokines and facilitate spirochete clearance. However, arthritic manifestations and chronic fatigue syndrome-like symptoms persist long after completion of antibiotic treatment regimens in a significant number of patients. To counter the effects of inflammation, treatment by non-steroidal anti-inflammatory drugs, hydroxychloroquine, or synovectomy to eradicate inflammatory arthritis in the involved joint could be employed; however, they often have long-term consequences. Acupuncture has been used for a long time in Asian medicine to diminish pain during various ailments, but the effects and its mechanism are just beginning to be explored. Control of inflammation by neuronal stimulation has been exploited as a systemic therapeutic intervention to arrest inflammatory processes. Our objective was to determine whether activation of the sciatic-vagal network by electroacupuncture on ST36 acupoint, which is used to control systemic inflammation in experimental models of infectious disorders such as endotoxemia, can also alleviate Lyme arthritis symptoms in mice. This aim was further strengthened by the reports that sciatic-vagal neuronal network stimulation can lead to dopamine production in the adrenal medulla and moderate the production of inflammatory factors. We first assessed whether electroacupuncture affects spirochete colonization to attenuate Lyme arthritis. Interestingly, bioluminescent burden detected by live imaging and qPCR were similar in electroacupuncture- and mock-treated mice, while electroacupuncture induced a lasting anti-inflammatory effect on mice. Despite the discontinuation of treatment at 2 weeks, the simultaneous decrease in neutrophils in the joints and inflammatory cytokine levels throughout the body at 4 weeks suggests a systemic and persistent effect of electroacupuncture that attenuates Lyme arthritis. Our results suggest that electroacupuncture-mediated anti-inflammatory responses could offer promising healthcare benefits in patients suffering from long-term Lyme disease manifestations.
Topics: Animals; Anti-Inflammatory Agents; Arthritis; Cytokines; Disease Susceptibility; Electroacupuncture; Inflammation; Lyme Disease; Mice; Mice, Inbred C3H; Vagus Nerve Stimulation
PubMed: 35924250
DOI: 10.3389/fimmu.2022.930287 -
Medicine Mar 2021Diffuse pigmented villonodular synovitis (PVNS) of knee is a rare benign disease that has a destructive clinical course. Synovectomy and adjuvant radiotherapy (RT) have... (Comparative Study)
Comparative Study
Diffuse pigmented villonodular synovitis (PVNS) of knee is a rare benign disease that has a destructive clinical course. Synovectomy and adjuvant radiotherapy (RT) have been reported as treatment options but literatures reporting functional outcomes were sparse. This study aimed to evaluate the long-term functional outcomes and disease control among treatment modalities through the 22 years of experience.A single-center database was searched for patients who received synovectomy of knee with the pathologic diagnosis of PVNS. General data, treatment modalities, and recurrent status were retrospectively collected from medical records. Functional outcomes were evaluated by Western Ontario and McMaster Universities Osteoarthritis Index through phone interviews by an independent orthopedist.From January 1995 to December 2017, 24 patients with diffuse PVNS of knee were identified, including 19 receiving open synovectomy (OP) and 5 undergoing arthroscopic surgery. Adjuvant RT was performed on 14 patients with a median dose of 35 Gy (range 20-40 Gy). After median follow up of 6 years, recurrences were recorded in 10 cases. The recurrence rate was significantly lower in the OP + RT group than the OP group (8.3% vs 57.1%, P = .038). Among those with preserved knee joints, there was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index score and stiffness score between patients in the OP + RT and OP groups.For patients with diffuse PVNS of knee, the addition of moderate-dose adjuvant RT following OP provided excellent local control while maintaining good joint function with limited treatment-related morbidity. Our study emphasized the importance of moderate dose RT in diffuse PVNS of knee joint.
Topics: Adult; Aged; Arthroscopy; Female; Follow-Up Studies; Humans; Knee Joint; Male; Middle Aged; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant; Range of Motion, Articular; Synovectomy; Synovitis, Pigmented Villonodular; Treatment Outcome; Young Adult
PubMed: 33761628
DOI: 10.1097/MD.0000000000023794 -
World Journal of Orthopedics Oct 2019The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes...
BACKGROUND
The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes and/or massive rotator cuff tendon tears, infection eradication can be challenging to achieve and the functional outcome is often not satisfying even after successful infection eradication. In such cases a two-stage approach with initial resection of the native infected articular surfaces, implantation of a cement spacer before final treatment with a total shoulder arthroplasty in a second stage is gaining popularity in recent years with the data in literature however being still limited.
AIM
To evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.
METHODS
We retrospectively included five consecutive patients over a five-year period and evaluated the therapeutic management and the clinical outcome assessed by disability of the arm, shoulder and hand (DASH) score and subjective shoulder value (SSV). All procedures were performed through a deltopectoral approach and consisted in a debridement and synovectomy, articular surface resection and insertion of a custom made antibiotic enriched cement spacer. Shoulder arthroplasty was performed in a second stage.
RESULTS
Mean age was 61 years (range, 47-70 years). Four patients had previous surgeries ahead of the septic arthritis. All patients had a surgical debridement ahead of the index procedure. Mean follow-up was 13 mo (range, 6-24 mo). Persistent microbiological infection was confirmed in all five cases at the time of the first stage of the procedure. The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer. There were two hemi and three reverse shoulder arthroplasties. Infection was successfully eradicated in all patients. The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70% respectively.
CONCLUSION
Short interval two-stage approach for septic shoulder arthritis is an effective treatment option. It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed.
PubMed: 31754606
DOI: 10.5312/wjo.v10.i10.356 -
EFORT Open Reviews Jun 2020Diffuse-type tenosynovial giant-cell tumours of the knee (D-TGCT) have a very high complication rate.The recurrence rate for D-TGCT is mainly dependent on an initially... (Review)
Review
Diffuse-type tenosynovial giant-cell tumours of the knee (D-TGCT) have a very high complication rate.The recurrence rate for D-TGCT is mainly dependent on an initially successful resection of the lesion.The standard of care for this disease involves early surgery with synovectomy. Available surgical techniques may include an arthroscopic or open surgery; however, there is a lack of consensus on which technique should be used, and when.Arthroscopic excision is effective in minimizing morbidity and surgery-related complications, while an open surgical technique provides a more successful resection with a lower incidence of local recurrence.We could not conclude with confidence which of the surgical techniques is better at stopping a progression towards osteoarthritis and the need for a total knee arthroplasty. Cite this article: 2020;5:339-346. DOI: 10.1302/2058-5241.5.200005.
PubMed: 32655889
DOI: 10.1302/2058-5241.5.200005 -
Arthroplasty after septic arthritis of the native hip and knee: retrospective analysis of 49 joints.Journal of Bone and Joint Infection 2022: Arthroplasty after septic arthritis (SA) treatment raises diagnostic and therapeutic questions. The main objective was to evaluate infection-free survival of patients...
: Arthroplasty after septic arthritis (SA) treatment raises diagnostic and therapeutic questions. The main objective was to evaluate infection-free survival of patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) post-SA. Other objectives were to describe the population's characteristics, surgical strategies, results of preoperative examinations and cultures of intraoperative samples taken at implantation, and postoperative antibiotic therapy. : This is a retrospective, observational, monocenter study, from January 2005 to May 2019, including all patients undergoing TKA or THA with prior or ongoing SA in the same joint. Infection-free survival was analyzed and reported. : Forty-seven patients, 29 men, 49 joints operated on (30 knees, 19 hips), were included. Median SA-to-arthroplasty interval was 32 [1-216] weeks. It was years for 43 joints and months for 19 joints. Six patients underwent arthroplasty while still on SA treatment. One-stage arthroplasty was done for 43 joints and two-stage arthroplasty for 6 joints. Eight (16 %) cultures of intraoperative specimens were positive. Median durations of postoperative antibiotic therapy were 10 d for sterile cultures and 82 d for those that were positive. At 2 years, infection-free survival rate was 95.9 % ( ). After a median follow-up of 47 [18-142] months, no SA relapse was observed, but five patients developed new periprosthetic joint infections (PJIs) with a different microorganism. : Arthroplasty may be a post-SA option, even within a short period of time. One-stage arthroplasty can be done if synovectomy is thorough, intraoperative samples are taken and antibiotics are administered until those culture results become available. We observed no SA relapse, but new PJIs occurred.
PubMed: 35464147
DOI: 10.5194/jbji-7-81-2022 -
Journal of Family Medicine and Primary... Oct 2022Rice bodies are formed mainly in tenosynovitis and bursitis of rheumatoid or tubercular origin. It rarely presents with compressive ulnar neuropathy. A 35-year-old...
Rice bodies are formed mainly in tenosynovitis and bursitis of rheumatoid or tubercular origin. It rarely presents with compressive ulnar neuropathy. A 35-year-old female presented with painful swelling in the volar aspect of the left wrist and incomplete flexion of the little finger. The laboratory tests revealed ESR 10 mm/1 hr and C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide tests were negative. Thickened and distended ulnar bursa with rice bodies was seen on magnetic resonance imaging (MRI). Thorough drainage, debridement, and synovectomy were done. Epithelioid cell granulomas with multinucleated giant cells on microscopy and the strongly positive Mantoux test prompted us to start anti-tubercular treatment. The wound healed uneventfully with good recovery of range of motion of the little finger at one-year follow up. Rice bodies can be a diagnostic dilemma in the absence of classical signs of their rheumatoid or tubercular origin.
PubMed: 36618161
DOI: 10.4103/jfmpc.jfmpc_786_22 -
Journal of Orthopaedic Case Reports Feb 2021Coccidioidomycosis is a fungal infection endemic to the Southwestern United States, Mexico, and South America. While uncommon, inhalation of spores or direct cutaneous...
INTRODUCTION
Coccidioidomycosis is a fungal infection endemic to the Southwestern United States, Mexico, and South America. While uncommon, inhalation of spores or direct cutaneous contact can lead to disseminated infection in the immunocompetent, with the involvement of the musculoskeletal and integumentary systems.
CASE REPORT
A 49-year-old patient with a history of pulmonary coccidioidomycosis presented with the right knee pain and multiple symptomatic abscesses beneath the suprapatellar and infrapatellar fat pads. Arthrocentesis and culture confirmed the infection, and open synovectomy, arthrotomy, and drainage of the infection were performed without complication.
CONCLUSION
Disseminated coccidioidomycosis is an uncommon fungal infection that may involve joints and become refractory to pharmacotherapy. Management may require surgical intervention, along with infectious disease consultation and close follow-up. Patients from endemic regions should be evaluated with a comprehensive history of this disease.
PubMed: 34141676
DOI: 10.13107/jocr.2021.v11.i02.3034 -
BMC Musculoskeletal Disorders Mar 2022Though radiotherapy has been widely used for knee pigmented villonodular synovitis (PVNS), there is few literatures about radiotherapy for the treatment of PVNS hip....
BACKGROUND
Though radiotherapy has been widely used for knee pigmented villonodular synovitis (PVNS), there is few literatures about radiotherapy for the treatment of PVNS hip. Thus, the purpose of this study was to analyze the clinical outcomes of endoscopic synovectomy with/without radiotherapy postoperatively of PVNS hip.
METHODS
We performed a retrospective study of patients who underwent endoscopy in our hospital from November 2010 to January 2021. Inclusion criteria was patients with magnetic resonance image (MRI) signs, endoscopic findings and/or histological evidence of PVNS. Exclusion criteria was patients lost follow-up. All patients underwent synovectomy endoscopically and were divided into two groups depending on receiving postoperative radiotherapy or not. The primary outcome measurements were the recurrence of PVNS, receiving revision, and/or converting to total hip arthroplasty (THA). The secondary outcome measurements were the patient-reported outcome (PRO) collected at pre- and post-operation, which consist of Hip Outcome Score Activities of Daily Living (HOS-ADL), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (IHOT-12), Non-arthritic Hip Scale (NAHS), and visual analog scale (VAS).
RESULTS
In a case series of 16 patients (8 cases of male, 50%), 4 (25%) cases were localized type and 12 (75%) cases were diffuse type. The average follow-up was 44.8 ± 38.2 months (range,3 to 110). 8 (50%) cases (6 diffuse cases and 2 localized cases) received radiotherapy postoperatively, and the rest (6 diffuse cases and 2 localized cases) received endoscopic treatment alone. At the latest follow-up, 3 (18.75%) cases (2 diffuse cases and 1 localized case) who did not receive radiotherapy converted to arthroplasty. The preoperative HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of remaining 13 patients were 63.1 ± 19.1 (range,32.0 to 98.8), 54.8 ± 20.1 (range, 10.0 to 77.0), 50.9 ± 15.4 (range, 31.0 to 76.6),51.6 ± 15.9 (range, 20.0 to 84.4), 6.0 ± 1.4 (range,4.0 to 8.0) points, respectively. The latest HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of the 13 patients were 79.7 ± 10.8 (range, 58.0 to 97.6), 78.6 ± 9.1 (range,55.0 to 87.0), 74.7 ± 9.7 (range, 55.6 to 91.0), 78.9 ± 18.7 (range,20.0 to 92.5), 3.1 ± 1.2 (range,2.0 to 6.0) points respectively.
CONCLUSION
Endoscopic synovectomy can achieve satisfactory PRO in PVNS hip patients. Besides, postoperative adjuvant radiotherapy can achieve higher hip survivability than synovectomy alone in this present study.
Topics: Activities of Daily Living; Arthroscopy; Endoscopy; Humans; Male; Radiotherapy, Adjuvant; Retrospective Studies; Synovectomy; Synovitis, Pigmented Villonodular; Treatment Outcome
PubMed: 35236301
DOI: 10.1186/s12891-022-05141-y -
International Journal of Surgery Case... Jul 2021Recurrent chronic synovitis due to foreign body is a rare entity and it may progress into chronic septic arthritis. Chronic recurrent synovitis or septic arthritis may...
INTRODUCTION & IMPORTANCE
Recurrent chronic synovitis due to foreign body is a rare entity and it may progress into chronic septic arthritis. Chronic recurrent synovitis or septic arthritis may leave permanent damage to the articular cartilage and renders the child with permanent disabilities.
CASE PRESENTATION
A 03-year-old girl has been transferred to a tertiary centre with a history of recurrent pain and swelling of the right knee and on and off limping for six weeks duration. These symptoms were preceded by a history of prick injury to the ipsilateral knee.
CLINICAL FINDINGS & INVESTIGATIONS
The knee was warm to the touch, moderately tender and contains effusion. C-Reactive peptide level series were elevated, Erythrocyte sedimentation rate was 83 mm/1 st hour and White cell count was 10,300/mm3. The ultrasonography revealed suprapatellar bursitis, other investigations such as Antinuclear antibody levels, Rheumatoid factor and Bacterial culture of the aspirate were negative.
INTERVENTIONS & OUTCOME
Arthrotomy and synovectomy performed. While performing synovectomy, an organic thorn has been retrieved from the Hoffa fat pad. The child was treated with intravenous antibiotics for ten days (Co-amoxiclav) and discharged. Her recovery was uneventful and in six weeks she has shown marked improvement of the knee function. Histological examination revealed non-specific chronic synovitis.
RELEVANCE & IMPACT
Chronic synovitis due to foreign body mimicking septic arthritis or causing diagnostic difficulty is a rare entity in the paediatric population. Careful clinical evaluation after creating a good rapport with the child is of utmost importance.
PubMed: 34157549
DOI: 10.1016/j.ijscr.2021.106124