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Medicine Sep 2018Due to the low incidence and lack of effective diagnostic measures for the diagnosis of metal allergy in patients undergoing total joint arthroplasty (TJA), diagnosis... (Review)
Review
RATIONALE
Due to the low incidence and lack of effective diagnostic measures for the diagnosis of metal allergy in patients undergoing total joint arthroplasty (TJA), diagnosis relies mainly on the exclusion of other causes, in particular infection. It remains a relatively unpredictable and poorly understood cause of implant failure. At present, skin patch testing, leukocyte migration inhibition test (LMIT) and lymphocyte transformation tests (LTT) are being commonly used to assess metal hypersensitivity.This report presents both a case and literature review.
PATIENT CONCERNS
A 61-year-old female patient experienced continuous swelling and pain in the right knee joint for 9 months after a right-side total knee arthroplasty (TKA).
DIAGNOSES
We believe this is the case report of metal allergy in TKA. The following were the reasons for this. First, no definite symptoms of infection during revision arthroplasty were observed, but with obvious hyperplasia of synovium. Furthermore, a frozen biopsy revealed an extremely low neutrophil count, which was considered to be caused by chronic inflammation. Second, the results of repeated post-operation reexaminations indicate a clear increase in the number of eosinophils, while no bacteria were found in the tissue bacterial smear performed during the operation. Third, improvements were clearly observed in the patient following synovectomy, revision of the polyethylene insert and anti-anaphylactic treatment.
INTERVENTIONS
The patient underwent synovectomy, revision of the polyethylene insert and anti-anaphylactic treatment.
OUTCOMES
The patient's right knee remained mildly swollen; however, the pain has been relieved significantly. The range of motion could achieve 0 degrees of extension and 90 degrees of flexion.
LESSONS
No consensus has been reached about the best diagnostic criteria for this disease, and most physicians would consider it to be a possibility when other diseases including periprosthetic joint infection (PJI) have been excluded. Although this case followed the same course, the outcome following synovectomy and anti-anaphylactic treatment further confirmed our hypothesis.
Topics: Arthroplasty, Replacement, Knee; Female; Humans; Hypersensitivity; Knee Prosthesis; Metals; Middle Aged; Polyethylene; Prosthesis Failure; Synovectomy; Synovial Membrane
PubMed: 30235744
DOI: 10.1097/MD.0000000000012475 -
International Journal of Health Sciences 2022Pigmented villonodular synovitis (PVNS) is a rare and benign lesion of unknown cause. Most cases reported in adult age patients. The diagnosing of PVNS is more difficult...
Pigmented villonodular synovitis (PVNS) is a rare and benign lesion of unknown cause. Most cases reported in adult age patients. The diagnosing of PVNS is more difficult in old age patients and might be confused with osteoarthritis. This article reviews detailed history, examination, and investigations of 79 years-old male patient with 5 years history of right knee pain and deformity. The patient was diagnosed with PVNS, and total synovectomy was performed, followed by constrained total knee arthroplasty. The present report aimed to highlight that the total synovectomy with total knee arthroplasty is a viable option with the advantage of favorable outcome in treating patients with PVNS associated with advanced osteoarthritis.
PubMed: 35599937
DOI: No ID Found -
Journal of Nuclear Medicine : Official... Jan 2005Radiosynovectomy (RSV) is a local intraarticular injection of radionuclides in colloidal form for radiotherapy. First used by Fellinger et al. in 1952, the technique has... (Review)
Review
Radiosynovectomy (RSV) is a local intraarticular injection of radionuclides in colloidal form for radiotherapy. First used by Fellinger et al. in 1952, the technique has now been applied for more than 50 y for treatment of resistant synovitis of individual joints after failure of long-term systemic pharmacotherapy and intraarticular steroid injections. RSV relieves pain and inflammation from rheumatoid arthritis (RA), for which it initially was used, and is accepted as an alternative to surgical synovectomy in cases of RA or other inflammatory arthropathies such as osteoarthritis and hemophiliac arthropathy. A good understanding of the clinical pathophysiology of the disease processes is mandatory, and close interdisciplinary collaboration with other clinicians who diagnose and treat patients is strongly suggested. Reported success rates range from 40% to 90% for the different joints and underlying diseases. A few well-designed prospective double-blind trials have evaluated the efficacy of RSV and justified the procedure as a viable option for treating chronic synovitis in RA or secondary to inflammatory arthropathies. In comparison with surgical synovectomy, RSV produces equivalent results, costs less, allows the patient to remain ambulatory, and is repeatable. RSV has to be considered the initial procedure of choice for the treatment of patients with hemarthrosis in hemophilia. In addition, local instillation of radiopharmaceuticals can effectively reduce effusions after implantation of a prosthesis.
Topics: Animals; Arthritis, Rheumatoid; Clinical Trials as Topic; Hemophilia A; Humans; Injections, Intra-Articular; Orthopedics; Pain; Patient Selection; Practice Guidelines as Topic; Practice Patterns, Physicians'; Radiation Injuries; Radioisotopes; Radiopharmaceuticals; Rheumatology; Synovitis; Treatment Outcome
PubMed: 15653651
DOI: No ID Found -
British Journal of Haematology Mar 2007Currently available factor concentrates for treatment of patients with haemophilia are virally inactivated or are made by recombinant technology and their broad use in... (Review)
Review
Currently available factor concentrates for treatment of patients with haemophilia are virally inactivated or are made by recombinant technology and their broad use in developed nations has resulted in the dramatic elimination of the treatment-related viral illnesses that decimated the haemophilia community in the late 20th century. The major morbidity experienced by patients with haemophilia today is joint disease, a result of repeated bleeding episodes into joint spaces. Although administration of factor concentrates to prevent bleeding has been demonstrated to prevent haemophilic joint disease when applied assiduously, repeated bleeding episodes induce synovitis that is irreversible and may progress despite subsequent prophylaxis. Surgical and nuclear medicine interventions are available to reduce the pain of haemophilic arthropathy and to reduce further bleeding episodes. Patients with high titre inhibitors are at great risk for the development of joint disease and present the greatest therapeutic challenges when joint surgery is needed.
Topics: Analgesia; Arthroplasty; Arthroscopy; Blood Coagulation Factors; Hemarthrosis; Hemophilia A; Humans; Physical Therapy Modalities; Synovectomy
PubMed: 17341263
DOI: 10.1111/j.1365-2141.2007.06490.x -
Journal of Ultrasonography Sep 2012Early diagnosis of rheumatoid arthritis followed by early initiation of treatment, prevent the destruction of joints and progression to disability in the majority of... (Review)
Review
Early diagnosis of rheumatoid arthritis followed by early initiation of treatment, prevent the destruction of joints and progression to disability in the majority of patients. A traditional X-ray fails to capture early inflammatory changes, while late changes (e.g. erosions) appear after a significant delay, once 20-30% of bone mass has been lost. Sonography and magnetic resonance imaging studies have shown that erosions are seen in the first 3 months from the appearance of symptoms in 10-26% of patients, while in 75% they are seen in the first 2 years of the disease. Power Doppler ultrasound and dynamic magnetic resonance studies allow for qualitative, semiquantitative and quantitative monitoring of the vascularization of the synovium. In addition, magnetic resonance enables assessment of the bone marrow. The ultrasonographic examination using a state-of-the-art apparatus with a high-frequency probe allows for images with great spatial resolution and for the visualization of soft tissues and bone surfaces. However, the changes seen in ultrasonography (synovial pathologies, the presence of exudate, tendons changes, cartilage and bone lesions, pathologies of tendon attachments and ligaments - enthesopathies) are not only specific for rheumatoid arthritis and occur in other rheumatic diseases. Qualitative methods are sufficient for diagnosing the disease through ultrasound or magnetic resonance imaging. Whereas semiquantitative and quantitative scales serve to monitor the disease course - efficacy of conservative treatment and qualification for radioisotope synovectomy or surgical synovectomy - and to assess treatment efficacy.
PubMed: 26673409
DOI: 10.15557/JoU.2012.0017 -
Acta Medica Portuguesa 2004Lipoma arborescens is a rare intraarticular lesion of unknown etiology. The disorder usually presents as painless swelling and recurrent joint effusion. It is typically... (Review)
Review
Lipoma arborescens is a rare intraarticular lesion of unknown etiology. The disorder usually presents as painless swelling and recurrent joint effusion. It is typically located in the knee (especially the suprapatellar bursa), though it has also been described in other joints. Laboratory test results are normal, as well as aspirated synovial fluid. Synovectomy is curative in most cases. The authors report a review of the literature, highlighting the importance of magnetic resonance imaging in the diagnosis of this pathology. Although it is a rare lesion, synovial lipoma arborescens should be included in the differential diagnosis of patients with a chronic swollen joint or recurrent joint effusions.
Topics: Bursa, Synovial; Diagnosis, Differential; Humans; Lipoma
PubMed: 15941559
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Mar 2018Many studies have proposed synovectomy during total knee arthroplasty (TKA) to reduce pain after TKA. The aim of this study was to assess the outcomes of synovectomy for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many studies have proposed synovectomy during total knee arthroplasty (TKA) to reduce pain after TKA. The aim of this study was to assess the outcomes of synovectomy for treating of TKA through a meta-analysis.
METHODS
Relevant clinical studies on synovectomy and without synovectomy were retrieved through searching the databases PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to January 2018. Studies that investigated the comparison of pain scores, total blood loss, range of motion, functional Knee Society Scores (KSSs), clinical KSSs, and operating time and provided sufficient data of interest were included in this meta-analysis. Stata 12.0 was used for meta-analysis.
RESULTS
Ten randomized controlled trials (RCTs) were finally included in this meta-analysis. Final results indicated that there was no significant difference between the pain scores, range of motion, functional Knee Society Scores (KSSs), and clinical KSSs (P > 0.05). However, synovectomy was associated with an increase of the total blood loss compared to patients without synovectomy (weighted mean difference (WMD) = 116.71, 95% confidence interval (CI) 78.63, 154.79, P = 0.000). Pooled results indicated that synovectomy was associated with an increase of the operating time (WMD = 15.44, 95% CI 2.67, 28.21, P = 0.018).
CONCLUSIONS
Current evidence indicates that synovectomy has no effects on the final clinical outcomes for patients undergoing TKA. It will increase the total blood loss and the operating time during TKA.
Topics: Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Humans; Knee Joint; Operative Time; Osteoarthritis, Knee; Pain, Postoperative; Range of Motion, Articular; Synovectomy
PubMed: 29530063
DOI: 10.1186/s13018-018-0752-y -
OncoTargets and Therapy 2022Tenosynovial giant cell tumor (TGCT) is a neoplasm of the joint synovium that can have severe impacts on joint mobility, function, and quality of life. Traditionally,... (Review)
Review
Tenosynovial giant cell tumor (TGCT) is a neoplasm of the joint synovium that can have severe impacts on joint mobility, function, and quality of life. Traditionally, treatment modalities included partial or complete surgical synovectomy, radiotherapy (typically as an adjunct to surgery), and watchful monitoring (no medical or surgical intervention). However, these approaches have been met with varying degrees of success and high recurrence rates, as well as onerous complications and clinical sequelae. Pexidartinib, a colony-stimulating factor 1 receptor (CSF1R) inhibitor, presents a promising molecular approach that targets a neoplastic driver of TGCT. While the introduction of pexidartinib allows clinicians to avoid the significant morbidity associated with traditional treatment options, there are also defined risks associated with pexidartinib treatment. Therefore, patient selection is critical in optimizing treatment modalities in TGCT. The purpose of this literature review is to identify the TGCT patient population that would derive maximal benefit with minimal risk from pexidartinib, and to determine the specific indications and contraindications for selecting pexidartinib over other therapeutic approaches. Specifically, this paper compares the efficacy and safety profile of pexidartinib across clinical and preclinical studies to that of surgery, radiotherapy, and watchful monitoring. Rates of improvement in joint mobility, pain, and recurrence-free survival across studies of pexidartinib have been encouraging. The most common adverse events are mild (hypopigmentation of the hair) or reversible (transient aminotransferase elevation). Severe or permanent adverse events (notably cholestatic hepatotoxicity) are rare. While the optimal treatment strategy remains highly dependent on a patient's clinical circumstances and treatment goals, pexidartinib has surfaced as a promising therapeutic in cases where the morbidity of surgery or radiotherapy outweighs the benefits.
PubMed: 35046667
DOI: 10.2147/OTT.S345878 -
Arthroscopy Techniques Jun 2017Peroneal tenosynovitis usually responds to conservative therapy. Early diagnosis and management are imperative because improper or delayed diagnosis and treatment of...
Peroneal tenosynovitis usually responds to conservative therapy. Early diagnosis and management are imperative because improper or delayed diagnosis and treatment of peroneal tenosynovitis may lead to progression of the tenosynovitis to peroneal tendon rupture, ultimately limiting the benefit of nonoperative treatment. For refractory cases, endoscopic tenosynovectomy is indicated. The purpose of this Technical Note is to report a minimally invasive approach to perform a synovectomy of zones 1 and 2 of the peroneal tendon sheath.
PubMed: 28706847
DOI: 10.1016/j.eats.2017.02.021 -
Hand (New York, N.Y.) Jan 2021The etiology of recurrent carpal tunnel syndrome (CTS) is unclear, and outcomes following secondary surgery in this demographic have been poorer than primary surgery.... (Review)
Review
The etiology of recurrent carpal tunnel syndrome (CTS) is unclear, and outcomes following secondary surgery in this demographic have been poorer than primary surgery. Fibrosis and hypertrophy have been identified in the flexor tenosynovium in these patients. The authors use flexor tenosynovectomy (FTS) for recurrent CTS after primary carpal tunnel release and present a review of these patients. A retrospective chart review was performed of 108 cases of FTS for recurrent CTS from 1995 to 2015 by 4 attending surgeons at one institution. Demographic information, symptoms, and outcomes were among the data recorded. A phone survey was conducted on available patients where the shortened version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) and satisfaction were assessed. Average office follow-up was 12 months. Average age was 57.5 years. A total of 104 (96%) reported symptom improvement and 48 (44%) reported complete symptom resolution. Forty patients were available for long-term follow-up at an average 6.75 years postoperatively via phone interview. Average QuickDASH score was 31.2 in these patients. Thirty-six (90%) of 40 patients were initially satisfied at last office visit, and 31 (78%) of 40 were satisfied at average 6.9 years, a maintenance of satisfaction of 86%. Satisfied patients were older (58 years) than unsatisfied patients (51 years). Both long-term satisfaction and QuickDASH scores in our cohort are consistent with or better than published results from nerve-shielding procedures. The authors believe a decrease in both carpal tunnel volume and potential adhesions of fibrotic or inflammatory synovium contributes to the benefits of this procedure. This remains our procedure of choice for recurrent CTS.
Topics: Carpal Tunnel Syndrome; Hand; Humans; Middle Aged; Retrospective Studies; Synovectomy; Wrist
PubMed: 30939941
DOI: 10.1177/1558944719840735