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Arthroscopy, Sports Medicine, and... Apr 2021To investigate the occurrence of heat-related complications from radiofrequency and electrocautery devices in patients undergoing arthroscopic surgery. (Review)
Review
PURPOSE
To investigate the occurrence of heat-related complications from radiofrequency and electrocautery devices in patients undergoing arthroscopic surgery.
METHODS
A systematic review was performed using the PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reporting complications after arthroscopy using electrosurgery devices were included. Only English- and Dutch-language articles were included. Basic science/nonclinical studies/human cadaveric studies and animal studies were excluded. Article selection was performed by 2 separate reviewers. Interobserver agreement of the selection procedure was determined by Cohen's kappa. All included articles were critically appraised using an adapted version of the ROBINS-I tool.
RESULTS
Twenty-five studies were included in this systematic review. A total of 309 cases of heat-related complications were identified. Chondrolysis was present in 45 cases and dermal burns in 15 cases. Axillary nerve injuries were reported in 197 cases of arthroscopic adhesive capsulitis release. However, it was unclear whether these injuries were directly related to the overheating of the arthroscopic fluid. No one specific risk factor for thermal complications was identified, but related factors included the leakage of the arthroscopy fluid, use of a thermal device continuously for a long period of time, proximity of the thermal device to the tissue, intra-articular local anesthetic injection or the use of intra-articular pain pumps, and certain surgical procedures, such as thermal capsulorrhaphy, capsular release, and synovectomy.
CONCLUSIONS
The most common heat-related complications in arthroscopy are dermal burns and chondrolysis. Risk factors include leakage of arthroscopy fluid, use of a thermal device, intra-articular anesthetics/pain pumps, and performing specific surgical procedures.
LEVEL OF EVIDENCE
Systematic review of level III-IV studies.
PubMed: 34027473
DOI: 10.1016/j.asmr.2020.12.002 -
JBJS Reviews Sep 2020Synovial chondromatosis (SC) of the ankle is a rare disorder in which metaplastic proliferation of synovia, tendon sheaths, and/or bursae leads to the formation of loose...
BACKGROUND
Synovial chondromatosis (SC) of the ankle is a rare disorder in which metaplastic proliferation of synovia, tendon sheaths, and/or bursae leads to the formation of loose cartilaginous bodies within the joint space. While SC itself is a benign condition, its sequelae can be chronic and debilitating if left untreated, or if there is postoperative recurrence. Arthritic degeneration and malignant transformation to chondrosarcoma are among the more serious complications in the natural history of the disease; the latter occurs in approximately 5% of cases. We performed a systematic review of the literature on the arthroscopic management of ankle SC in order to better understand recurrence patterns and suggest an alternative approach to open arthrotomy.
METHODS
Using predetermined inclusion and exclusion criteria, the PubMed and Embase databases were searched for relevant articles related to arthroscopic surgical management of patients with confirmed SC of the ankle. Article selection and data abstraction were performed in 3 steps by 3 independent reviewers.
RESULTS
The initial search retrieved 116 articles, of which 15 were included. Those studies included 22 patients (14 to 63 years of age; 77% male) who were followed for a mean of 27 months (range, 8 weeks to 12 years) postoperatively. The cases represented a mix of primary and secondary SC etiologies, and almost entirely stage-III disease. Arthroscopic synovectomy with excision of loose bodies was a consistent feature of treatment, and bursectomy, debridement of osteochondral lesions or involved tendons, and osteophyte resection were performed as indicated. All but 1 case employed an anterior approach including anteromedial and anterolateral portals, and in several cases a 4-portal technique was used, which was subsequently proposed as a necessary approach for the definitive treatment of ankle SC. On the basis of the available data, complication and recurrence rates following arthroscopic management were very low.
CONCLUSIONS
A growing pool of evidence is emerging to suggest favorable outcomes for arthroscopic treatment of SC of the ankle joint. However, more data on patient and surgical variables, as well as comparative studies with longer follow-up, are needed in order to draw definitive conclusions.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Ankle Joint; Arthroscopy; Chondromatosis, Synovial; Humans
PubMed: 33151646
DOI: 10.2106/JBJS.RVW.20.00045 -
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 -
The Cochrane Database of Systematic... Jul 2019Osteoarthritis affecting the knee is common and represents a continuum of disease from early cartilage thinning to full-thickness cartilage loss, bony erosion, and...
BACKGROUND
Osteoarthritis affecting the knee is common and represents a continuum of disease from early cartilage thinning to full-thickness cartilage loss, bony erosion, and deformity. Many studies do not stratify their results based on the severity of the disease at baseline or recruitment.
OBJECTIVES
To assess the benefits and harms of surgical intervention for the management of symptomatic mild to moderate knee osteoarthritis defined as knee pain and radiographic evidence of non-end stage osteoarthritis (Kellgren-Lawrence grade 1, 2, 3 or equivalent on MRI/arthroscopy). Outcomes of interest included pain, function, radiographic progression, quality of life, short-term serious adverse events, re-operation rates and withdrawals due to adverse events.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase up to May 2018. We also conducted searches of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform for ongoing trials. Authors of trials were contacted if some but not all their participants appeared to fit our inclusion criteria.
SELECTION CRITERIA
We included randomised controlled trials that compared surgery to non-surgical interventions (including sham and placebo control groups, exercise or physiotherapy, and analgesic or other medication), injectable therapies, and trials that compared one type of surgical intervention to another surgical intervention in people with symptomatic mild to moderate knee osteoarthritis.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials and extracted data using standardised forms. We analysed the quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach.
MAIN RESULTS
A total of five studies involving 566 participants were identified as eligible for this review. Single studies compared arthroscopic partial meniscectomy to physical therapy (320 participants), arthroscopic surgery (debridement ± synovectomy ± chondroplasty) to closed needle joint lavage with saline (32 participants) and high tibial osteotomy surgery to knee joint distraction surgery (62 participants). Two studies (152 participants) compared arthroscopic surgery (washout ± debridement; debridement) to a hyaluronic acid injection. Only one study was at low risk of selection bias, and due to the difficulty of blinding participants to their treatment, all studies were at risk of performance and detection bias.Reporting of results in this summary has been restricted to the primary comparison: surgical intervention versus non-surgical intervention.A single study, included 320 participants with symptoms consistent with meniscal tear. All subjects had the meniscal tear confirmed on knee MRI and radiographic evidence of mild to moderate osteoarthritis (osteophytes, cartilage defect or joint space narrowing). Patients with severe osteoarthritis (KL grade 4) were excluded. The study compared arthroscopic partial meniscectomy and physical therapy to physical therapy alone (a six-week individualised progressive home exercise program). This study was at low risk of selection bias and outcome reporting biases, but was susceptible to performance and detection biases. A high rate of cross-over (30.2%) occurred from the physical therapy group to the arthroscopic group.Low-quality evidence suggests there may be little difference in pain and function at 12 months follow-up in people who have arthroscopic partial meniscectomy and those who have physical therapy. Evidence was downgraded to low quality due to risk of bias and imprecision.Mean pain was 19.3 points on a 0 to 100 point KOOS pain scale with physical therapy at 12 months follow-up and was 0.2 points better with surgery (95% confidence interval (CI) 4.05 better to 3.65 points worse with surgery, an absolute improvement of 0.2% (95% CI 4% better to 4% worse) and relative improvement 0.4% (95% CI 9% better to 8% worse) (low quality evidence). Mean function was 14.5 on a 0 to 100 point KOOS function scale with physical therapy at 12 months follow-up and 0.8 points better with surgery (95% CI 4.3 better to 2.7 worse); 0.8% absolute improvement (95% CI 4% better to 3% worse) and 2.1% relative improvement (95% CI 11% better to 7% worse) (low quality evidence).Radiographic structural osteoarthritis progression and quality of life outcomes were not reported.Due to very low quality evidence, we are uncertain if surgery is associated with an increased risk of serious adverse events, incidence of total knee replacement or withdrawal rates. Evidence was downgraded twice due to very low event rates, and once for risk of bias.At 12 months, the surgery group had a total of three serious adverse events including fatal pulmonary embolism, myocardial infarction and hypoxaemia. The physical therapy alone group had two serious adverse events including sudden death and stroke (Peto OR 1.58, 95% CI 0.27 to 9.21); 1% more events with surgery (95% CI 2% less to 3% more) and 58% relative change (95% CI 73% less to 821% more). One participant in each group withdrew due to adverse events.Two of 164 participants (1.2%) in the physical therapy group and three of 156 in the surgery group underwent conversion to total knee replacement within 12 months (Peto OR 1.76, 95% CI 0.43 to 7.13); 1% more events with surgery (95% CI 2% less to 5% more); 76% relative change (95% CI 57% less to 613% more).
AUTHORS' CONCLUSIONS
The review found no placebo-or sham-controlled trials of surgery in participants with symptomatic mild to moderate knee osteoarthritis. There was low quality evidence that there may be no evidence of a difference between arthroscopic partial meniscectomy surgery and a home exercise program for the treatment of this condition. Similarly, low-quality evidence from a few small trials indicates there may not be any benefit of arthroscopic surgery over other non-surgical treatments including saline irrigation and hyaluronic acid injection, or one type of surgery over another. We are uncertain of the risk of adverse events or of progressing to total knee replacement due to very small event rates. Thus, there is uncertainty around the current evidence to support or oppose the use of surgery in mild to moderate knee osteoarthritis. As no benefit has been demonstrated from the low quality trials included in this review, it is possible that future higher quality trials for these surgical interventions may not contradict these results.
Topics: Arthroscopy; Humans; Osteoarthritis, Knee; Pain Measurement; Quality of Life; Randomized Controlled Trials as Topic; Severity of Illness Index
PubMed: 31322289
DOI: 10.1002/14651858.CD012128.pub2 -
JBJS Reviews Apr 2019Lipoma arborescens is a rare, intra-articular benign lesion characterized by hyperplastic formation of villous projections that commonly presents as nonspecific...
BACKGROUND
Lipoma arborescens is a rare, intra-articular benign lesion characterized by hyperplastic formation of villous projections that commonly presents as nonspecific mechanical knee pain. The treatment of choice for lipoma arborescens of the knee is open or arthroscopic synovectomy. However, data are lacking on the success of arthroscopic treatment, despite its increasingly widespread use. We aimed to systemically review the outcomes of arthroscopic treatment of lipoma arborescens.
METHODS
PubMed and Embase were searched by 2 reviewers independently on October 9, 2018, and all relevant articles in the English and French languages up to and including that date were considered. The search terms "lipoma arborescens," "knee," "arthroscopy," and "arthroscopic" were used. Articles were screened on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
RESULTS
Among the 110 initial studies that were retrieved, 28 satisfied the inclusion criteria. A total of 71 knees in 65 patients ranging from 13 to 78 years of age underwent arthroscopic synovectomy for the treatment of lipoma arborescens. The duration of follow-up ranged from 3 weeks to 84 months. The recurrence rate was 2.8%, and 2 patients underwent conversion to open surgery. One patient had postoperative hematoma that required evacuation, and another patient reported persistent residual pain at the time of the latest follow-up.
CONCLUSIONS
On the basis of this uncontrolled, systematic review, arthroscopic synovectomy is a safe and effective treatment for lipoma arborescens of the knee, with a success rate of >95%.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Arthroscopy; Humans; Joint Diseases; Knee Joint; Lipoma; Synovectomy; Synovial Membrane; Treatment Outcome
PubMed: 31021893
DOI: 10.2106/JBJS.RVW.18.00139 -
European Review For Medical and... Apr 2019The aim of this study was to review the characteristics of patients with septic arthritis after ACL reconstruction comparing our results with those deriving from the...
OBJECTIVE
The aim of this study was to review the characteristics of patients with septic arthritis after ACL reconstruction comparing our results with those deriving from the literature review.
PATIENTS AND METHODS
Patients with suspected post arthroscopic septic arthritis of the knee occurring within 6 months after surgery were evaluated to be included in the investigation. Septic arthritis was defined by i) clinical evidence; ii) laboratory investigations; iii) synovial fluid leukocyte count of more than 2,5 x 104/μL or positive cultures obtained by synovial fluid aspirate.
RESULTS
Thirty-nine patients (median age 25 years, range 17-42) with septic arthritis following ACL reconstruction were enrolled. Staphylococci were the main bacteria identified. Resolution within 4 weeks of local signs was observed more frequently in those receiving arthroscopic debridement and synovectomy coupled with antibiotic therapy (18/21 vs. 9/18, p<0.05). Fever was present in 33 (85%) cases. Fever disappearance and CRP normalization within 4 weeks were reported more frequently in patients receiving intravenous antibiotics (17/20 vs. 9/19, p<0.05). Similar findings were retrieved by literature analysis.
CONCLUSIONS
An intravenous antibiotic therapy with surgical debridement is the first-line treatment for septic arthritis. Staphylococci are the main causative agents, justifying an empiric therapeutic approach with an anti-MRSA agent and cephalosporin.
Topics: Anti-Bacterial Agents; Arthritis, Infectious; Arthroscopy; Cephalosporins; Glycopeptides; Humans; Injections, Intravenous; Methicillin-Resistant Staphylococcus aureus; Treatment Outcome
PubMed: 30977874
DOI: 10.26355/eurrev_201904_17477 -
European Journal of Orthopaedic Surgery... Apr 2019Pseudoaneurysms (PA) are rare complications following ankle arthroscopy (AA). Delay in diagnosis is reported to be frequent and could lead to serious complications....
BACKGROUND/OBJECTIVE
Pseudoaneurysms (PA) are rare complications following ankle arthroscopy (AA). Delay in diagnosis is reported to be frequent and could lead to serious complications. Evidence synthesis on the clinical context of such complication lacks in the literature.
METHODS
A systematic review is conducted to locate all relevant papers. In total, 23 case reports were included in the review. Data of 23 patients with a mean of 40.9 ± 10.3 years were extracted and analyzed. Outcomes included comorbidities, portals and procedure types performed during AA, PA location and size, time to diagnosis and treatment, and therapeutic modalities.
RESULTS
The results showed that d-ATA and the dorsal pedis artery (DPA) were involved in 18 and 4 cases, respectively. A single case of PA of the fibular artery was described. The mean PA size was found to be 4.2 × 3.9 × 2.1 cm. Five of the 14 patients (35.7%) with a reported detailed medical history were treated for a cardiovascular or hemostasis condition. Delay in PA diagnosis was found to be at a mean time of 50.45 ± 74.6 days. The most commonly reported surgical indications were anterior synovectomy and removal of anterior osteophytes. Ligation was the most common procedure in treating PA.
CONCLUSION
While portal placement might be a minor factor, the variability of the d-ATA and/or DPA anatomical position and its affection with foot position and distraction during AA could play a role in the arterial injury. Synovectomy and removal of anterior, particularly big-sized, osteophytes could be considered as risk factors as well. A state of hypocoagulability might affect injury healing and consequently PA formation. PA diagnosis should be raised whenever a non-resolving or pulsatile swelling over a portal incision is observed.
Topics: Aneurysm, False; Ankle Joint; Arteries; Arthroscopy; Delayed Diagnosis; Humans; Osteophyte; Synovectomy
PubMed: 30361987
DOI: 10.1007/s00590-018-2324-6 -
Journal of Maxillofacial and Oral... Dec 2018Synovial chondromatosis (SC) is a benign condition that is characterized by the formation of cartilaginous nodules within the synovial tissue of a joint that may detach... (Review)
Review
AIM
Synovial chondromatosis (SC) is a benign condition that is characterized by the formation of cartilaginous nodules within the synovial tissue of a joint that may detach and form loose bodies inside the articular space. The purpose of this study is to evaluate the use of surgical arthroscopy for the treatment of SC of the temporomandibular joint (TMJ).
MATERIALS AND METHODS
A series of six patients treated with arthroscopy (one patient requiring an open arthrotomy due to the size of the loose bodies) in our centre between 1997 and 2016 is presented and results are discussed. A systematic review of the literature of patients with SC treated with arthroscopy or arthroscopy-assisted open arthrotomy is also carried out.
RESULTS
Pain, which was the main symptom in our patients, and maximum mouth opening both improved significantly after surgical treatment. Three of the patients were diagnosed with primary SC, and the other 3 had a previous diagnosis of internal derangement. None of the patients showed signs of relapse during the follow-up period.
CONCLUSIONS
Surgical arthroscopy is a minimally invasive procedure that allows the extraction of loose bodies and even partial synovectomy of the affected membrane with good results and without recurrence of the disease. This technique can be useful in cases of SC with loose bodies measuring less than 3 mm or without extra-articular extension.
PubMed: 30344377
DOI: 10.1007/s12663-018-1102-7 -
Surgical Technology International Jun 2018Unicompartmental knee arthroplasty (UKA) effectively improves pain and function associated with isolated compartmental knee arthritis. The developments of... (Review)
Review
INTRODUCTION
Unicompartmental knee arthroplasty (UKA) effectively improves pain and function associated with isolated compartmental knee arthritis. The developments of computer-navigated and robotic-assisted UKA are among the most significant changes that have improved patient outcomes. This study aimed to systematically review the literature to identify differences between computer-navigated and robotic-assisted UKAs.
MATERIALS AND METHODS
Twenty total articles were identified. Data pertaining to demographics, outcomes, and complications/failures were extracted from each study. Reoperation/revision rates, indications for reoperation/revision, type of procedure, and number of patients who underwent conversion to TKA (when available) were recorded.
RESULTS
Nine studies reported 451 computer-navigated medial UKAs, with 19 (3.9%) reportedly requiring reoperation: primary revision (n=8; 42.1%), conversion to TKA (n=6), and manipulation under anesthesia (n=5). Eleven studies reported 2,311 robotic-assisted UKAs (74 lateral UKAs), with 106 (5.0%) requiring reoperation: conversion to TKA (n=46; 43.4%), primary revision (n=43), reoperations without component-removal (n=15), subchondroplasty, and partial meniscectomy/synovectomy (both n=1). Reoperation rate discrepancy between computer-navigated and robotic-assisted UKA was not statistically significant (p=0.495); age and BMI differed between both groups (p<0.0001).
DISCUSSION
This study represents the first known comparison of revision rates of computer-navigated and robotic-assisted UKA, suggesting that these methods can benefit orthopaedic surgeons, especially those new to UKA or in a low-volume practice.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Female; Humans; Knee Joint; Male; Middle Aged; Postoperative Complications; Reoperation; Robotic Surgical Procedures; Treatment Outcome
PubMed: 29611157
DOI: No ID Found -
Arthritis Care & Research Sep 2018We undertook a systematic review and meta-analysis of direct and indirect trial evidence to evaluate the efficacy of treatments for patients with undifferentiated... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
We undertook a systematic review and meta-analysis of direct and indirect trial evidence to evaluate the efficacy of treatments for patients with undifferentiated arthritis (UA).
METHODS
We searched 4 electronic databases from inception to January 2016, clinicaltrials.gov, and bibliographies of relevant articles. Two reviewers independently screened and evaluated the studies. The primary outcome was development of rheumatoid arthritis (RA).
RESULTS
Nine studies were included. Interventions included methotrexate, abatacept, infliximab, intraarticular or intramuscular glucocorticoids, and radiation synovectomy. Treating patients resulted in lower rates of RA at 12 months compared to placebo or no treatment (odds ratio [OR] 0.49 [95% confidence interval (95% CI) 0.26, 0.90]). From direct meta-analysis, patients treated with methotrexate were less likely to develop RA at 12 months compared to patients treated without methotrexate (OR 0.13 [95% CI 0.03, 0.48]). This difference was no longer significant at 30 or 60 months. From indirect comparisons, most interventions showed decreased risk of developing RA compared to placebo at 12 months, reaching statistical significance for methotrexate (OR 0.16 [95% CI 0.08, 0.33]) and intramuscular methylprednisolone (OR 0.72 [95% CI 0.53, 0.99]). Most individual interventions included a limited number of studies.
CONCLUSION
Treating patients with UA resulted in a statistically significant delay in the development of RA, with the largest effect observed for methotrexate. These findings suggest that there is a window of opportunity to treat patients with UA early, to delay subsequent progression to RA.
Topics: Antirheumatic Agents; Arthritis; Chronic Disease; Humans; Secondary Prevention
PubMed: 29161466
DOI: 10.1002/acr.23474