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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 -
Joint Bone Spine May 2018Radioisotope synovectomy has been extensively used to treat patients with chronic inflammatory joint disease but has moved to a less prominent position since the... (Review)
Review
Radioisotope synovectomy has been extensively used to treat patients with chronic inflammatory joint disease but has moved to a less prominent position since the introduction of new and highly effective drugs. Remaining indications are refractory synovitis, pigmented villonodular synovitis as an adjunct to surgery, and hemophilic arthropathy. The three main radioisotopes used are yttrium-90, rhenium-186, and erbium-189. Radioisotope synovectomy should be performed only by highly experienced professionals, to minimize the risk of injection-related complications. The available safety data, in particular regarding the risk of malignancy, are reassuring. The efficacy of yttrium-90 in chronic inflammatory joint disease remains controversial.
Topics: Arthritis; Brachytherapy; Chronic Disease; Female; Humans; Injections, Intra-Articular; Male; Prognosis; Radioisotopes; Rhenium; Risk Assessment; Severity of Illness Index; Synovectomy; Synovitis, Pigmented Villonodular; Treatment Outcome; Yttrium Radioisotopes
PubMed: 28652100
DOI: 10.1016/j.jbspin.2017.06.002 -
Clinics in Podiatric Medicine and... Jan 1988Synovectomy has developed as a useful adjunct in the treatment of various arthritic manifestations. The history, methods, and some applications of synovectomy as well as...
Synovectomy has developed as a useful adjunct in the treatment of various arthritic manifestations. The history, methods, and some applications of synovectomy as well as the rationale for it have been addressed. More data need to be gathered with respect to the joints of the foot. Although often overlooked in the foot, synovectomy has distinct applications that provide an alternative to more morbid procedures.
Topics: Arthritis; Humans; Methods; Synovectomy
PubMed: 2962724
DOI: No ID Found -
Physica Medica : PM : An International... Mar 2018Rheumatoid arthritis (RA) is a chronic inflammatory disease that can potentially damage the synovial joints. One of the effective treatment modality for RA is radiation... (Review)
Review
Rheumatoid arthritis (RA) is a chronic inflammatory disease that can potentially damage the synovial joints. One of the effective treatment modality for RA is radiation synovectomy (RSV) where properly selected radionuclide is injected into the joint space, enabling controlled destruction of diseased synovial membrane via radiation exposure. Radiation dosimetry in RSV appears challenging due to the heterogeneous nature of synovial membrane, nonuniform distribution and leakage of radionuclide from the synovial cavity. This article reviews the dosimetric perspective pertaining to RSV. Specifically, characteristics of radionuclide for RSV and radiation dose to target and non-target (i.e., articular cartilage, bone, bloodstream, gonads, etc.) tissues of patient have been discussed. The personal dose H(0.07) to the hands of medical staff (i.e., radiochemist, therapist physician, nurse) may be considerably high due to handling of high specific activities (∼500 MBq/ml for Y-90); such doses are typically measured using thermoluminescence dosimeters (TLD) ring dosimeters and ranges from 1 to 21.5, 0.1 to 40 and 0.1 to 5 µSv/MBq for the radiochemist, therapist physician and the nurse, respectively. Methods to minimize radiation doses to the patient, medical staff and public are elaborated. Contamination risks and precautionary measures are also reported.
Topics: Arthritis, Rheumatoid; Humans; Neoplasms, Radiation-Induced; Organs at Risk; Radiation Dosage; Radiometry; Synovectomy
PubMed: 29609820
DOI: 10.1016/j.ejmp.2018.02.015 -
Zeitschrift Fur Rheumatologie Apr 2022In accordance with the rheumatological concept of "hit hard and early", the timing of synovectomy should also be selected to be as early as possible and should be...
In accordance with the rheumatological concept of "hit hard and early", the timing of synovectomy should also be selected to be as early as possible and should be adjusted to the onset of the effect of biologicals in order to prevent joint destruction. This means that after an early diagnosis of rheumatoid arthritis and start of drug therapy, a low disease activity has been achieved and a rebellious joint is evident, a very prompt synovectomy is indicated.
Topics: Arthritis, Rheumatoid; Humans; Knee Joint; Synovectomy; Synovitis
PubMed: 35089382
DOI: 10.1007/s00393-021-01113-0 -
The Journal of Knee Surgery May 2017The objective of this study is to assess pain, function, and morbidity in patients undergoing synovectomy during primary total knee arthroplasty (TKA) for osteoarthritis... (Meta-Analysis)
Meta-Analysis Review
The objective of this study is to assess pain, function, and morbidity in patients undergoing synovectomy during primary total knee arthroplasty (TKA) for osteoarthritis (OA). A meta-analysis, which included randomized controlled trials comparing TKA with and without synovectomy for OA, was completed. The primary outcome was postoperative knee pain. Secondary outcomes included performance, perioperative complications, validated functional scores, operation length, and hospitalization length. A literature search produced 487 unique references, of which 3 randomized controlled trials were selected for inclusion. A total of 304 patients (354 knees) were included, with an average age of 67 years. Follow-up intervals between studies ranged from 26 weeks to 12 months. Included studies were of moderate- to high-quality evidence with low risk of bias. There was no significant difference between the two groups in regard to postoperative pain, Knee Society Score, or postoperative range of motion. Postoperative blood loss was significantly lower in synovium-retaining TKA group (MD = 99.41 mL; 95% confidence interval, 45.08-153.75). Based on these results, there is currently no evidence to support the use of synovectomy in TKA for primary OA, as it provides no clinical benefit and increases postoperative blood loss.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Osteoarthritis, Knee; Pain, Postoperative; Postoperative Hemorrhage; Range of Motion, Articular; Synovectomy
PubMed: 27380472
DOI: 10.1055/s-0036-1584560 -
Hand Clinics Nov 2005Arthroscopic synovectomy is a safe outpatient procedure with minimal postoperative morbidity. In patients who have rheumatoid arthritis and possibly also in patients who... (Review)
Review
Arthroscopic synovectomy is a safe outpatient procedure with minimal postoperative morbidity. In patients who have rheumatoid arthritis and possibly also in patients who have JRA, SLE, and postinfectious arthritis, a long period of increased comfort and improved function can be anticipated. The procedure may be considered in post-traumatic cases with joint contracture and as an adjunct to other measures for certain osteoarthritic disorders. In patients who have septic arthritis with insufficient clinical improvement after systemic antibiotics and lavage, arthroscopic synovectomy seems advantageous.
Topics: Arthritis; Arthroscopy; Humans; Synovectomy; Wrist Joint
PubMed: 16274861
DOI: 10.1016/j.hcl.2005.08.007 -
Medicine Jan 2023
Topics: Humans; Arthritis, Juvenile; Synovectomy; Knee Joint
PubMed: 36607889
DOI: 10.1097/MD.0000000000032634 -
Current Opinion in Rheumatology Feb 1991This is a review of current concepts of rheumatoid collapse deformities, and the current treatment options available to those caring for the rheumatoid wrist and hand.... (Review)
Review
This is a review of current concepts of rheumatoid collapse deformities, and the current treatment options available to those caring for the rheumatoid wrist and hand. It presents an overview to familiarize the clinician with the deformities and their causes, and the techniques and materials available to restore function to the rheumatoid hand.
Topics: Arthritis, Rheumatoid; Arthrodesis; Arthroplasty; Hand; Humans; Synovectomy; Wrist
PubMed: 2043437
DOI: 10.1097/00002281-199102000-00016 -
Revue de Chirurgie Orthopedique Et... Dec 2004
Review
Topics: Arthroscopy; Humans; Knee Joint; Synovectomy
PubMed: 15711496
DOI: 10.1016/s0035-1040(04)70758-8