Chronic Nonspecific Synovitis Research Articles

Function of arthroscopy for early diagnosis and early therapeutic intervention in knee synovitis compared to histopathology

Background and Aim: Osteoarthritis (OA) is the most common form of arthritis and a major cause of joint pain and disability. Synovial fluid analysis and biopsy have been found to be a valuable adjunct to conventional investigations and are routinely advised in most cases of joint diseases. Needle arthroscopy of the knee has been advocated as it allows good macroscopic evaluation of synovial inflammation and selective sampling of the synovial membrane thereby overcoming the disadvantage of closed needle biopsy.Material and Methods: In the decided study period, total of 60 cases were selected as per the inclusion and exclusion criteria decided prior to the start of the study. The clinical examination with movements in knee joints, valgus stress test, lachman test amd McMurrays test was done. After initial arthroscopic inspection, the structures like anterior cruciate ligament, medial and lateral menisci, tested and seen for their integrity and consistency. The synovial fluid was sent for cytology, culture and for biochemistry. The data was analyzed using proportions.Results: Overall in 24 cases the clinical diagnosis differed from that of gold standard i.e. histopathology. In six cases the diagnosis was chronic non-specific synovitis but it turned out to be Osteoarthritis on histopathology. In two cases the clinical diagnosis was chronic non-specific synovitis but it turned out to be pyogenic synovitis on histopathology. In two cases the clinical diagnosis was chronic non-specific synovitis but it turned out to be Villonodular synovitis s on histopathology. In six cases the diagnosis was septic arthritis but it turned out to be gouty arthritis on histopathology.Conclusion: Thus arthroscopic diagnosis can be relied upon and treatment can be started on this basis in view of time consuming and costly histopathological tests.

HISTOMORPHOLOGICAL PATTERNS OF SYNOVIAL LESIONS: A STUDY AT TERTIARY CARE HOSPITAL.

Introduction: Synovium is the soft tissue that lines the spaces of diarthrodial joints, tendon sheaths, and bursae derived from the ectoderm consisting of two components, predominantly a cellular layer, and a second layer made up of fibrous and adipose tissues. Chondrocytes being elements of hyaline cartilage secrete degenerative enzymes in inactive forms and enrich the matrix with enzyme inhibitors. Synovial lesions are characterized by the destruction of hyaline cartilage, due to the activation of degenerative enzymes and decreasing the production of their inhibitors. Materials and methods: It’s a retrospective study of 104 synovial biopsies received in 5 years at a tertiary care hospital. Synovial biopsies were obtained mainly by the open method and a few by the arthroscopic method. Lesions were classified into infective, degenerative, inflammatory, benign, tumor, and tumor-like lesions. Results: Out of 104 lesions, ganglion cyst was commonest 45 cases [43.26%] followed by chronic non-specific synovitis was 15 cases [14.42%], baker’s cyst was 11 cases [10.57%], giant tumor cells of tendon sheath was 09[8.65%], few cases such as tubercular synovitis, rheumatoid arthritis, lipoma arborescens was 2 cases each [1.92%], one case each of septic arthritis, synovial cavernous hemangioma, villonodular synovitis were also noted. The most common age group affected was 31-40 years of age [20.19 %]. Males was predominantly affected in our study [50.96%] Conclusion: Many synovial lesions show similar clinical presentation so histopathological classification is useful to identify its subtypes and the study of synovial biopsy is useful in the diagnosis of various joint diseases.

Efficacy of synovial fluid analysis and synovial biopsy in diagnosing joint pathologies

Efficacy of synovial fluid analysis and synovial biopsy in diagnosing joint pathologies - IJOR- Print ISSN No: - 2581-8112 Online ISSN No:- 2581-9151 Article DOI No:- 10.18231/2455-6777.2018.0015, IP International Journal of Orthopaedic Rheumatology-IP Int J Orthop Rheumatol

Study of histomorphological features of synovial biopsy in joint diseases

Introduction: The histopathological examination of synovial biopsy plays an important role in arriving at correct diagnosis in joint disease presenting as unclassified arthritis, suspicious of granulomatous disease, deposition disease or infectious disease. Objectives: To study the histomorphological features of synovial biopsy in joint diseases. Materials and Methods: This was a prospective study conducted in the Department of Pathology, K V G Medical College and Hospital, Sullia, D.K. In the present study 50 cases of synovial lesions were evaluated histopathologically. Results: Histomorphological examination of 50 synovial biopsies revealed the following lesions: Chronic non specific synovitis was the commonest synovial lesion encountered in 30 (60%) cases followed by 6 (12%) cases of Ganglion cyst, 4 (8%) cases of Septic arthritis, 3 (6%) cases of Baker’s cyst, 2(4%) cases each of Synovial chondromatosis and Rheumatoid Arthritis and 1 (2%) case of Cavernous hemangioma. Conclusion: It was concluded that most of the cases in our study was that of chronic nonspecific synovitis. This could be due to early stage of Rheumatoid arthritis, osteoarthritis and other seronegative arthritis. Hence, these patients should be closely followed up and repeat biopsies should be carried out as they may present with specific diagnostic features in their due course. Keywords: Synovitis, Arthritis, Syovial biopsy, Histomorphological features.

Interpretation of synovial biopsy –A retrospective study

Interpretation of synovial biopsy –A retrospective study - ACHR- Print ISSN No: - 2581-5725 Online ISSN No:- 2456-9267 Article DOI No:- 10.18231/j.achr.2019.039, IP Archives of Cytology and Histopathology Research-IP Arch Cytol Histopathol Res

Histomorphological study of synovial lesions

Background: The synovium is a specialized mesenchymal tissue that is required for appropriate function of locomotor apparatus. Synovium is the site for a series of pathologic processes that are characteristic and in some cases are specific to distinctive disease. The histopathological examination of the synovial tissue plays a pivotal role in arriving at correct diagnosis in joint disease presenting as unclassified arthritis, suspicious of granulomatous disease, deposition disease or infectious disease with negative synovial fluid analysis. Objectives: To study the histomorphological features of various synovial lesions and to evaluate synovial scoring. Materials and Methods: In the present study 104 cases of synovial lesions were evaluated histopathologically. Results: Out of the 104 cases, chronic nonspecific synovitis (56.7%) was the commonest synovial lesions, followed by tubercular synovitis (12.5%) and Baker’s cyst (10.5%). Synovial scoring was applicable in 85 cases and they were grouped into specific and non-specific synovitis. Interpretation & Conclusion: Majority of the synovial lesions could be classified into various subgroups by histopathological features. The high incidence of chronic nonspecific synovitis may represent a smoldering infection where the causative agent is not demonstrable. In cases of early rheumatoid arthritis, the histopathological features might be non- specific, however if there is strong clinical suspicion then it is worthwhile to do serological test for rheumatoid factor and synovial scoring. Synovial scoring was higher in cases of rheumatoid arthritis and was of less significance in conditions like granulomatous disease, metabolic disease, Lipoma arborescence and Hoffa’s disease. Larger studies are needed to assess the reproducibility of synovial scoring system in the evaluation of synovial lesions.

Retrospective study of synovial biopsies-Tertiary centre experience

Introduction: Advancement in medical technology has increased life expectancy. Replacement surgeries have become a common procedure because of aging, affordable population. Also, awareness and affordability of simple techniques like synovial biopsies help in specific diagnosis and treatment. As our hospital is a tertiary government orthopaedic institution, replacement surgeries are done regularly. There are few published data and literature on synovial lesions. Hence, we took up this study to analyse the pattern of synovial lesions. Aim and Objectives: To study the histopathological spectrum of synovial biopsies done for diagnostic evaluation and during replacement surgeries. Materials and Methods: The present study comprised of retrospective analysis of synovial lesions diagnosed from July 2015 to June 2018 at Sanjay Gandhi Institute of Trauma & Orthopedics, Bangalore. Total of 214 biopsies were analyzed. Relevant clinical and radiological details were obtained. Synovial biopsy specimens were processed routinely and wherever necessary special stains like Zeihl -Neelsen stain for AFB and Prussian blue stain for hemosiderin were carried out. Lesions were classified under main categories of inflammatory joint diseases, degenerative joint diseases and tumor and tumor like conditions. Results: In our study, the common age groups affected were between 50-70years. Males were affected more. Most common symptoms were pain and swelling. Knee was the commonest joint involved. Most common histopathological diagnosis was chronic nonspecific synovitis followed by tuberculous synovitis, septic arthritis and rheumatoid arthritis. Also cases of benign tumors such as synovial lipoma arborescence, synovial lipoma, chondromatosis, and pigmented villonodular synovitis were noted in present study. Conclusion: Histological analysis of synovial biopsies proves to be a valuable tool in establishing an early and specific diagnosis. Keywords: Synovial biopsy, Histopathology, Non speci

A prospective study for definitive diagnosis of various arthropathies by synovial fluid analysis and percutaneous needle biopsy of synovium

Objectives: To evolve a diagnostic pattern of synovial fluid analysis, thus determining the usefulness of routine synovial fluid analysis as a simple diagnostic aid in various forms of arthritis. Background: Synovial fluid analysis is a simple, inexpensive investigation, whereby, based on simple laboratory tests and the physical characteristics of the synovial fluid, definitive diagnosis of various arthritis could be arrived at. Synovial fluid aspiration is a simple OPD procedure. It does not need much expertise. It could be performed in all hospitals including the primary health centre. Methods: 50 patients with joint effusion attending the orthopaedic outpatient department of our hospital, were selected at random. They were examined clinically, subjected to routine laboratory investigations, radiology and then synovial fluid aspiration was done under aseptic precautions and sent to biochemistry, pathology and microbiology departments for synovial fluid analysis. Doubtful cases based on synovial fluid analysis reports, were subjected to histopathological examination. Results: Out of the 50 cases, 13 cases were diagnosed as osteoarthritis, 12 as traumatic arthritis/ haemarthrosis, 6 patients were diagnosed as tuberculous arthritis, 5 as septic arthritis and 5 patients as rheumatoid arthritis. One case each was diagnosed as gouty arthritis and neuropathic joint effusion. 7 cases were diagnosed as chronic non-specific synovitis as no definitive diagnosis could be arrived at, after interpreting the synovial fluid analysis findings and histopathological examination. Interpretation and Conclusion: Synovial fluid analysis is a satisfactory procedure in terms of both diagnosis as well as patient’s compliance point of view, especially in a patient of rural area and lower socio-economic strata. Diagnosis of various arthropathies can be obtained and obtained early in a significant number of cases. The technique can eliminate unnecessary treatment and possibly, the need for an arthrotomy.

A study on the outcome of arthroscopic synovial biopsy and synovectomy in the management of chronic synovitis of the knee

<p class="abstract"><strong>Background:</strong> Synovitis of the knee can be very difficult to treat especially when the diagnosis remains elusive. Synovitis occurs because of various causes. We assess the patients presenting to our hospital with synovitis of the knee, who underwent arthroscopic synovial biopsy and partial arthroscopic synovectomy and did a review of literature.</p><p class="abstract"><strong>Methods:</strong> This retrospective study included 25 patients with chronic synovitis of the knee presenting to our institution between July 2012 to January 2016. Inclusion criteria were patients presenting with persistent swelling of the knee; not responding to conservative measures. We excluded patients who had recurrent synovitis, patients who had septic arthritis. All patients underwent Arthroscopic synovial Biopsy and partial synovectomy. Preoperative and postoperative VAS score was calculated.<strong></strong></p><p class="abstract"><strong>Results:</strong> In n=6 patients the histopathological diagnosis was Tuberculosis, which improved with Anti tuberculous drug treatment. In n=1 patient the diagnosis was lipoma arborescens, in n=1 patient the diagnosis was plant thorn synovitis, in n=3 patient the diagnosis was Juvenile rheumatoid arthritis; all 5 patients improved with synovectomy and NSAIDS. In n=14 patients the biopsy report came as chronic non-specific synovitis, 8 of these patients did well with arthroscopic synovectomy while the other 6 had a recurrence. The average VAS score improved from 8.8- pre surgery to 4.7 post surgery.</p><p class="abstract"><strong>Conclusions:</strong> Arthroscopic synovial biopsy and synovectomy gives good results in patients with chronic synovitis of the knee. It may be recommended as a treatment for chronic synovitis of the knee, which is not responding to conservative measures of treatment.</p>

Spectrum of synovial lesions with a rare case report of lipoma arborescens

Context: Synovium is the site for a series of pathologic processes that are characteristic and in some cases specific, to a particular disease. Examination of the synovial biopsies plays a key role in the diagnosis of joint diseases as the disease affecting the joints can have varied clinical presentations. Materials and Methods: We present here the different spectrum of synovial lesions that was diagnosed on synovial biopsy. Results: There were ten cases of synovium and related diseases which includes two cases of Chronic nonspecific synovitis, one case of Septic arthritis, two cases of Tuberculous synovitis, one case of Rheumatoid arthritis, one case of Tenosynovial giant cell tumor of tendon sheath, one case of Synovial lipomatosis, and two cases of Secondary chondromatosis. Conclusion: This series highlights the various spectrums of joint diseases. Synovial biopsy is an important and final tool for definitive diagnosis of joint disorders. Correlation with clinical, radiological, and serological findings helps to arrive at an accurate diagnosis.

Atypical presentation of intra-articular osteochondroma of knee in adolescent- case report

<p>Osteochondroma is most common benign bone tumor around knee joint. They occur during the period of growth, grows away from joint line and rarely responsible for mechanical symptoms. This paper reports a rare presentation of intra-articular osteochondroma in knee with mechanical instability symptoms, mild to moderate pain and swelling of knee joint. Patient was 20 years old male and misdiagnosed as chronic nonspecific synovitis, tubercular arthritis and anterior cruciate ligament tear of knee. We assessed him clinically and radiologically and diagnosis was established based on MRI and arthroscopy. He was treated by open excision of tumor, and patients recover uneventfully. Instability of knee joint in this case can be attributed due to rough surface of osteochondroma just beneath lower attachment of patellar tendon.</p>

Comparison of Arthroscopic, Radioactive and Combined Synovectomy in the Treatment of Chronic Non-Specific Knee Synovitis

Objective: To compare the outcomes of arthroscopic, radioactive and combined synovectomies in patients with chronic non-specific recurrent synovitis who did not respond to conservative therapy. Subjects and Methods: Twenty-nine patients enrolled between 2007 and 2011 were divided into 3 groups: group 1 was treated with arthroscopy, group 2 received a radioactive drug and group 3 received a combined (radioactive and arthroscopic) synovectomy. Treatment efficacy was evaluated by comparing pre- and post-operative Lysholm knee scores (LKS), night pain, resting pain, activity pain and effusions using visual analogue scales (VAS). Patient satisfaction was assessed using the visual analogue patient satisfaction scale (VAPSS). Results: The mean age of the study participants was 41.5 ± 5.2 years (range 14-76), and the mean follow-up period was 33.6 ± 3.2 months (range 17-78). Before treatment, the mean LKS was 41.4 ± 3.4 in group 1, 39.6 ± 3.3 in group 2 and 37.1 ± 4.6 in group 3. After treatment, the corresponding mean LKS were 77.7 ± 2.1, 81.6 ± 2.8 and 91.3 ± 2.7 in groups 1, 2 and 3, respectively; the increase was statistically significant (p < 0.05). The VAS scores before and after treatment decreased significantly (p < 0.05). The mean VAPSS score, a measure of patient satisfaction, was 5.1 ± 1.7, 5.8 ± 1.5 and 7.4 ± 1.8 in groups 1, 2 and 3, respectively, and the difference between groups 1 and 2 was not statistically significant, while that between group 3 and the other two groups was significant (p < 0.05). Conclusion: This study showed that the three methods used in individuals with chronic non-specific recurrent synovitis were effective; however, arthroscopic synovectomy in combination with radioactive synovectomy was more effective than the other methods and superior in terms of patient satisfaction.

Combined arthroscopic synovectomy and radiosynoviorthesis in the treatment of chronic non-specific synovitis of the knee

Chronic non-specific synovitis has a higher recurrence rate with arthroscopic synovectomy due to the insufficient removal of all pathological tissues. Neither has radiosynoviorthesis been sufficiently effective in treatment in contrast to cases of chronic specific synovitis such as rheumatoid arthritis. This study aimed to investigate the efficiency of combined arthroscopic and radionuclide synovectomy in chronic non-specific synovitis of the knee with the evaluation of clinical and radiological results. 14 knees of 14 patients (11 female, 3 male) diagnosed as chronic non-specific synovitis were treated with arthroscopic subtotal synovectomy combined with radiosynoviorthesis. The efficiency was evaluated retrospectively by comparing preoperative and postoperative modified cincinnati knee score, Visual Analogue Scale, joint USG and MRI. The mean age was 29.2 ± 10.3 years and the mean follow-up period was 30.3 ± 3.7 months. Clinical parameters such as pain, limitation of motion and effusion were regressed. Daily activities at the final follow-up were significantly better than in the preoperative period. The mean modified cincinnati knee score of the patients increased from 25.8 ± 8.7 preoperatively to 67.8 ± 13.4 postoperatively (p = 0.002). The mean VAS score was 7.2 ± 1.1 preoperatively and 1.3 ± 0.8 postoperatively (p = 0.003). Clinically and radiologically on MRI there was no recurrence. Mean synovial membrane thickness was 4.5 ± 2.4 mm in the preoperative period. At the final follow-up, noticeable regression of synovial membrane thickness (2.1 ± 0.5 mm) was recorded in the knee joint USG (p = 0.015). No complications were observed. The combination of arthroscopic subtotal synovectomy and radiosynoviorthesis can be an effective treatment modality for chronic non-specific synovitis of the knee.

Radiation synovectomy therapy combined with surgical synovectomy in chronic nonspecific synovitis of the knee joint

This study aims to investigate the effectiveness of the radiation synovectomy (RS) procedure combined with the surgical synovectomy in the treatment of chronic nonspecific synovitis, which are resistant to medical treatment. Between March 2004 and October 2009, 17 knees of the 17 patients (15 males, 2 females; mean age 42.5 years; range 27 to 70 years) who underwent synovectomy surgery, followed by RS procedure with the 90Y at six weeks were included. At the end of a mean 48.7 months (range; 15-126 months) follow-up period, the Lysholm Knee Scale scores were used for functional assessment before and after RS procedure. The nocturnal pain, resting pain, activity pain and effusion were evaluated with the visual analog scale. The patient satisfaction was recorded as excellent, very good, good and poor. At the end of the follow-up period, all patients had satisfaction scores of excellent and very good. There was a statistically significant difference between all assessment scores before and after treatment (p<0.05). It was found that none of the cases had radionuclide leakage from the joint in their control scintigraphy following RS procedure. No significant complication was seen except for deep vein thrombosis developed in one case. Our study results showed that RS procedure combined with the surgical synovectomy is an effective and safe treatment method for the treatment of cases of chronic nonspecific synovitis which recurs despite medical treatment.

Arthroscopic synovial biopsy in definitive diagnosis of joint diseases: An evaluation of efficacy and precision.

Context:Arthritis is an important cause of morbidity, presenting as monoarticular or polyarticular lesion. Arthroscopic synovial aspiration and biopsy can help in arriving specific etiological diagnosis.Aim and Objectives:To evaluate the efficacy of arthroscopic synovial biopsy as a diagnostic aid and study the characteristics of synovial fluid in various joint diseases.Materials and Methods:Arthroscopic synovial biopsy along with synovial fluid analysis was studied in 30 of the 50 enrolled cases arthritis. The fluid was subjected to physical, biochemical, and cytological analysis.Results:Both rheumatoid (n = 14, 28%) and tubercular (n = 13, 26%) arthritis were found to be more common compared to other etiologies. Next common etiology observed was chronic nonspecific synovitis (n = 10, 20%). Clinicopathological correlation was seen in 34 out of 50 cases. As a diagnostic tool, synovial biopsy had a sensitivity of 85%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 62%.Conclusion:Arthroscopic synovial biopsy is a simple and easy to perform technique and is an important useful investigative adjunct that may give conclusive diagnosis where clinical diagnosis is equivocal.

Arthroscopic debridement and biological resurfacing of the glenoid in glenohumeral arthritis

The purpose of this study was to analyse the intermediate-term results of an arthroscopic procedure to debride and resurface the arthritic glenoid, in a middle-aged population, using an acellular human dermal scaffold. Between 2003 and 2005, thirty-two consecutive patients underwent an arthroscopic debridement and biological glenoid resurfacing for glenohumeral arthritis. The diagnoses included primary osteoarthrosis (28 patients), arthritis after arthroscopic reconstruction for anterior instability (1 patient) and inflammatory arthritis (3 patients). All shoulders were assessed clinically using the Constant and Murley score, and results graded according to Neer's criteria. Statistical analysis was performed to determine significant parameters and associations. A significant improvement (P < 0.0001) in each parameter of the subjective evaluation component (severity of pain, limitation in daily living and recreational activities) of the Constant score was observed. The Constant and Murley score increased significantly (P < 0.0001) from a median of 40 points (range 26-63) pre-operatively to 64.5 (range 19-84) at the final assessment. Overall, the procedure was considered as "successful outcome" in 23 patients (72%) and as a "failure" in 9 patients (28%). According to Neer's criteria, the result was categorized as excellent in 9 (28%), satisfactory in 14 (44%) and unsatisfactory in 9 (28%). Within the unsatisfactory group, there were five conversions to prosthetic arthroplasty. A standard magnetic resonance imaging was performed on 22 patients in the successful outcome group; glenoid cartilage was identified in 12 (thick in 5, intermediate in 1, thin in 6) and could not be identified in 10 patients (complete/incomplete loss in 5, technical difficulties in 5). Overall, five complications included transient axillary nerve paresis, foreign-body reaction to biological material, inter-layer dissociation, mild chronic non-specific synovitis and post-traumatic contusion. Dominance of affected extremity and generalized disease (diabetes, rheumatoid arthritis, generalized osteoarthritis) was associated with an unsatisfactory outcome (P < 0.05). Arthroscopic debridement and biological resurfacing of the glenoid is a minimally invasive therapeutic option for pain relief, functional improvement and patient satisfaction, in glenohumeral osteoarthritis, in the intermediate-term.

Aseptic synovitis after meniscal repair using the biodegradable Meniscus Arrow

We report a case of aseptic synovitis in a 19-year-old man. The synovitis of the left knee developed 13 months after meniscal repair using the biodegradable Meniscus Arrow (Bionx Inc, Malvern, PA). Histologic examination revealed chronic nonspecific synovitis and birefringent materials. Immunohistochemical tests were positive in lysozyme, α-1-antitrypsin, and α-1-antichymotrypsin. After arthroscopic synovectomy, pain and swelling of the knee joint were relieved and the patient's range of motion fully recovered. We have found no previous report of aseptic synovitis accompanying meniscal repair using the biodegradable Meniscus Arrow.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 77–80

Tendovaginitis stenosans: a frequent complication of carpal tunnel syndrome

Of 1310 patients surgically treated for carpal tunnel syndrome (CTS), 134 (10.2%) were observed to have one or more trigger fingers or de Quervain's disease. Of a total of 205 fingers, the middle finger was affected 75 times, the ring finger 50 times, the thumb 47 times, the small finger 17 times, and the index finger 16 times. Chronic nonspecific synovitis is commonly suspected as the cause of both diseases. In all cases of carpal tunnel syndrome, the patient should therefore be examined for symptoms of concomitant trigger finger and vice versa. Both can be cured surgically under local anesthesia and bloodless field in a single session.