-
International Journal of Surgery Case... Apr 2024Mono-arthritis and intermetatarsal bursitis according to rheumatoid arthritis aren't aware among general orthopedic surgeon. This report describes a case of surgical...
INTRODUCTION
Mono-arthritis and intermetatarsal bursitis according to rheumatoid arthritis aren't aware among general orthopedic surgeon. This report describes a case of surgical treatment of intermetatarsal bursitis.
PRESENTATION OF CASE
A 50-year-old female presented with three years of metatarsophalangeal joint pain and deformity. MRI showed bursitis and synovial proliferation around the joint. Synovectomy reduced pain and foot deformity. After surgery, the patient was administered methotrexate.
DISCUSSION
There were previous studies reporting intermetatarsal bursitis associated with rheumatoid arthritis, few case reports were found in which surgery and pathological examination were performed.
CONCLUSION
Intermetatarsal bursitis is common for patients with rheumatoid arthritis. Early diagnosis and early appropriate treatment is necessary.
PubMed: 38503164
DOI: 10.1016/j.ijscr.2024.109537 -
Medicine Mar 2024Pseudomonas aeruginosa-induced septic arthritis is a relatively uncommon phenomenon. It has been documented in children with traumatic wounds, young adults with a...
RATIONALE
Pseudomonas aeruginosa-induced septic arthritis is a relatively uncommon phenomenon. It has been documented in children with traumatic wounds, young adults with a history of intravenous drug use, and elderly patients with recent urinary tract infections or surgical procedures.
PATIENT CONCERNS
Fifty-nine year-old female had no reported risk factors. The patient sought medical attention due to a 6-month history of persistent pain and swelling in her right ankle.
DIAGNOSES
Magnetic resonance imaging and a 3-phase bone scan revealed findings suggestive of infectious arthritis with concurrent osteomyelitis. Histopathological examination of the synovium suggested chronic synovitis, and synovial tissue culture confirmed the presence of P aeruginosa.
INTERVENTION
Arthroscopic synovectomy and debridement, followed by 6 weeks of targeted antibiotic therapy for P aeruginosa.
OUTCOMES
Following treatment, the patient experienced successful recovery with no symptom recurrence, although she retained a mild limitation in the range of motion of her ankle.
LESSONS
To our knowledge, this is the first reported case of chronic arthritis and osteomyelitis caused by P aeruginosa in a patient without conventional risk factors. This serves as a crucial reminder for clinicians to consider rare causative organisms in patients with chronic arthritis. Targeted therapy is imperative for preventing further irreversible bone damage and long-term morbidity.
Topics: Humans; Child; Female; Middle Aged; Young Adult; Aged; Ankle; Pseudomonas Infections; Tomography, X-Ray Computed; Anti-Bacterial Agents; Arthritis, Infectious; Osteomyelitis; Pseudomonas aeruginosa
PubMed: 38457596
DOI: 10.1097/MD.0000000000037344 -
Journal of Orthopaedic Case Reports Feb 2024This case report describes the third documented example of primary esophageal carcinoma metastasizing to the patella and the first documented example of esophageal...
INTRODUCTION
This case report describes the third documented example of primary esophageal carcinoma metastasizing to the patella and the first documented example of esophageal carcinoma metastasizing to synovium.
CASE REPORT
A 67-year-old man with a history of metastatic esophageal carcinoma presents with right knee pain and an aggressive, destructive lesion involving the superior patella. Biopsy revealed esophageal carcinoma. After ineffective radiation, he underwent resection of the tumor-filled bone and quadricep advancement. Two months later, a recurrent tumor involving the entire patella and significant knee synovitis was observed. He underwent a total patellectomy with a radical anterior synovectomy. Further assessment showed that the entire synovium was replaced with metastatic carcinoma.
CONCLUSION
This report describes an atypical presentation of metastasis with patella and synovium involvement.
PubMed: 38420244
DOI: 10.13107/jocr.2024.v14.i02.4218 -
Cureus Jan 2024Synovial chondromatosis is a rare and benign disorder that involves the synovial lining of joints, synovial sheaths and bursae. The synovial layer of the joint is...
Synovial chondromatosis is a rare and benign disorder that involves the synovial lining of joints, synovial sheaths and bursae. The synovial layer of the joint is affected by a metaplastic process which in turn converts it into cartilagenous tissue. Eventually, it gets dislodged and transformed into a loose body in the large joints. We report the case of a 24-year-old young athlete who presented with complaints of painful movements and restriction of joint movements associated with a growing deformity in the right knee joint. This case report aims to describe a rare synovial pathology that necessitated arthroscopic synovectomy and diagnostic arthroscopy to treat, particularly in younger individuals. The atypical feature, in this case, was metaplastic development from the peripheral joint capsule attached to the surrounding cartilage, which, to the extent that the authors are aware, has only been documented in one instance in the record. Magnetic resonance imaging (MRI) was performed which demonstrated evidence of the joint effusion, synovial hypertrophy and a loose calcific body just anterior of the distal femoral condyle causing pressure over the patellar tendon anteriorly as well as a hyper-dense cyst in the popliteal region. Treatment often requires partial or complete synovectomy with either an arthroscopic or open approach.
PubMed: 38420086
DOI: 10.7759/cureus.53173 -
Turkish Journal of Haematology :... Mar 2024
Topics: Humans; Hemophilia A; Synovectomy; Rifampin; Recurrence
PubMed: 38323390
DOI: 10.4274/tjh.galenos.2024.2023.0420 -
Journal of Clinical Medicine Jan 2024Persistent knee synovitis leads to joint discomfort, incapacitating inflammation, and functional limitations. The conventional approach has involved surgical procedures...
BACKGROUND
Persistent knee synovitis leads to joint discomfort, incapacitating inflammation, and functional limitations. The conventional approach has involved surgical procedures to eliminate the actively inflamed synovial membrane. This study aims to investigate the recurrence-free survival and functional outcome after synovectomy and subsequent radiosynoviorthesis (RSO) in patients with knee synovitis.
METHODS
Thirty-seven knees diagnosed with pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), and peripheral spondyloarthritis underwent synovectomy and subsequent RSO between May 2005 and October 2016. The mean age was 34.9 ± 15.1 years, and the mean follow-up period was 84 ± 36.4 months. Clinical outcomes were assessed using the Oxford Knee Score and the presence of swelling and pain at the last follow-up. Recurrence-free survival denotes the duration from synovectomy to surgical re-synovectomy.
RESULTS
In general, twelve knees underwent re-synovectomy after a mean follow-up of 34.8 ± 24.9 months. The recurrence-free survival was 83.8% at two years, 71.3% at five years, and 61.7% at ten years. The subgroup analysis revealed recurrence-free survival at two years in 63.6% of patients with PVNS, 86.7% of those with RA, and 100% of individuals with peripheral spondyloarthritis.
CONCLUSIONS
This study demonstrates that combined therapy for synovitis is an effective approach, significantly improving clinical outcomes.
PubMed: 38276107
DOI: 10.3390/jcm13020601 -
Medicina (Kaunas, Lithuania) Jan 2024Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability....
Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco's zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure.
Topics: Humans; Tenodesis; Orthopedic Procedures; Tendons; Leg; Arthralgia; Chronic Pain
PubMed: 38256365
DOI: 10.3390/medicina60010104 -
Cancers Jan 2024Tenosynovial giant cell tumor (TSGCT) is a rare soft tissue tumor that involves the synovial lining of joints, bursae, and tendon sheaths, primarily affecting young... (Review)
Review
Tenosynovial giant cell tumor (TSGCT) is a rare soft tissue tumor that involves the synovial lining of joints, bursae, and tendon sheaths, primarily affecting young patients (usually in the fourth decade of life). The tumor comprises two subtypes: the localized type (L-TSGCT) and the diffuse type (D-TSGCT). Although these subtypes share histological and genetic similarities, they present a different prognosis. D-TSGCT tends to exhibit local aggressiveness and a higher recurrence rate compared to L-TSGCT. Magnetic resonance imaging (MRI) is the preferred diagnostic tool for both the initial diagnosis and for treatment planning. When interpreting the initial MRI of a suspected TSGCT, it is essential to consider: (i) the characteristic findings of TSGCT-evident as low to intermediate signal intensity on both T1- and T2-weighted images, with a blooming artifact on gradient-echo sequences due to hemosiderin deposition; (ii) the possibility of D-TSGCT-extensive involvement of the synovial membrane with infiltrative margin; and (iii) the resectability and extent-if resectable, synovectomy is performed; if not, a novel systemic therapy involving colony-stimulating factor 1 receptor inhibitors is administered. In the interpretation of follow-up MRIs of D-TSGCTs after treatment, it is crucial to consider both tumor recurrence and potential complications such as osteoarthritis after surgery as well as the treatment response after systemic treatment. Given its prevalence in young adult patents and significant impact on patients' quality of life, clinical trials exploring new agents targeting D-TSGCT are currently underway. Consequently, understanding the characteristic MRI findings of D-TSGCT before and after treatment is imperative.
PubMed: 38254890
DOI: 10.3390/cancers16020402 -
Lupus Science & Medicine Jan 2024With scarce data on the need and type of joint surgery in SLE, we investigated the long-term rates and underlying causes for arthroplasty, arthrodesis and synovectomy in...
AIM
With scarce data on the need and type of joint surgery in SLE, we investigated the long-term rates and underlying causes for arthroplasty, arthrodesis and synovectomy in patients with SLE.
METHODS
Procedure dates for arthroplasty, arthrodesis or synovectomy were retrieved from the state-wide Hospital Morbidity Data Collection between 1985 and 2015 for patients with SLE (n=1855) and propensity-matched controls (n=12 840). Patients with SLE with ≥two additional diagnostic codes for rheumatoid arthritis were classified as rhupus. ORs and incidence rates (IRs) per 100 person-years for joint procedures (JPs) were compared among patients with rhupus, patients with other SLE and controls across three study decades by regression analysis.
RESULTS
More patients with SLE than controls underwent a JP (11.6% vs 1.3%; OR 10.8, CI 8.86 to 13.24) with a higher IR for JP in patients with SLE (1.9 vs 0.1, rate ratio 19.9, CI 16.83 to 23.55). Among patients with SLE, patients with rhupus (n=120, 60.5%) had the highest odds of arthroplasty (OR 4.49, CI 2.87 to 6.92), arthrodesis (OR 6.64, CI 3.28 to 12.97) and synovectomy (OR 9.02,CI 4.32 to 18.23). Over time, the IR for overall JP in patients with rhupus was unchanged (8.7 to 8.6, R=0.004, p=0.98), although the IR for avascular necrosis underlying arthroplasty decreased for all patients with SLE (0.52 to 0.10, p=0.02). Patients with other SLE also had significantly higher OR and IR for all three JPs than controls with insignificant decreases in synovectomy and increases in arthroplasty over time in this group.
CONCLUSIONS
The overall burden of joint surgery in SLE is high and despite a reduction in avascular necrosis, arthroplasty and arthrodesis rates have not decreased over time. These data indicate a need for increased efforts to prevent joint damage in patients with lupus.
Topics: Humans; Cohort Studies; Lupus Erythematosus, Systemic; Arthritis, Rheumatoid; Longitudinal Studies; Necrosis
PubMed: 38199862
DOI: 10.1136/lupus-2023-001045 -
Heliyon Dec 2023Undifferentiated arthritis is a disease that clinically presents with symptoms and signs of inflammatory arthritis but does not meet the specific diagnostic criteria of...
Undifferentiated arthritis is a disease that clinically presents with symptoms and signs of inflammatory arthritis but does not meet the specific diagnostic criteria of rheumatoid arthritis (RA) or spondyloarthropathy. Here, we report our experience with a patient whose diagnosis of RA was delayed due to a lack of evidence for RA. The patient complained of knee joint swelling and pain, but the clinical features did not match those of typical pyogenic arthritis. Because infection could not be completely ruled out, the patient was treated for pyogenic arthritis using arthroscopic synovectomy and antibiotics. However, the pain was not relieved and the rheumatologist suggested a diagnosis of undifferentiated monoarthritis, which is an early stage of RA. The pain eventually spread to other joints, leading to the diagnosis of RA, approximately two months after the initial visit. Considering undifferentiated arthritis and making appropriate differential diagnoses is important to avoid unnecessary treatments such as surgery or prolonged antibiotic use. Awareness of the possibility of undifferentiated monoarthritis, an early stage of RA, may be helpful in treating patients with recurrent knee effusion.
PubMed: 38076190
DOI: 10.1016/j.heliyon.2023.e22631