Partial Synovectomy Research Articles

Synovial hemangioma localized in the knee joint and diagnosed in adulthood: MRI findings and surgical treatment

Synovial hemangioma is a rare vascular issue that can lead to persistent knee swelling and bleeding within the joint. It is typically seen in children and young adults but can also affect those in older age groups. Because the symptoms and x-ray results are not specific, it is often diagnosed late. Magnetic Resonance Imaging (MRI) is the best process for identifying and understanding the characteristics of synovial hemangioma. The recommended treatments are surgical removal and partial synovectomy, both of which offer good outcomes and minimal chance of recurrence. We discuss a case of a 48-year-old man with synovial hemangioma in the knee joint. His symptoms included swelling, pain, and restricted movement. His medical history included regular drainage of persistent knee swelling. An MRI highlighted typical features of synovial hemangioma, such as enlarged veins, looped or linear patterns, and greater visibility under gadolinium. He underwent a successful open surgery with partial synovectomy and mass removal. The pathology report confirmed the diagnosis of synovial hemangioma. Post-surgery, the patient had no complications and showed significant symptom reduction and better movement range 6 months later.

Paper 49: Osteochondral Allograft Transplantation for Capitellar Osteochondritis Dissecans: Excellent Patient Reported Outcomes Scores and High Return to Sports

Objectives: Unstable osteochondritis dissecans of the capitellum (OCD-C) is treated surgically, most commonly with loose body removal and marrow stimulation. This treatment has historically been associated with suboptimal return to high-demand upper extremity sports (baseball and gymnastics) and persistent elbow pain. Fresh osteochondral allograft transplantation (OAlloT) is an alternative treatment which restores subchondral bone and articular cartilage without donor site morbidity associated with autograft harvest. The purpose of this study was to evaluate the outcomes of osteochondral allograft transplantation in pediatric patients with unstable OCD-C 10mm or greater in size. Methods: A single-center prospective study was performed of consecutive pediatric patients, less than 19 years of age, with unstable OCD-C 10mm or greater in size treated with primary fresh OCAlloT using pre-cut 10mm, 12mm, or 16mm cores. Imaging, including radiographs and MRI were obtained preoperatively to assess OCD size and characteristics, as well as postoperatively to assess incorporation of the OCA. Patient reported outcome scores (PROs), including sport data, were obtained preoperatively and annually following surgery. Minimum follow-up duration was 2 years. Results: 26 elbows in 24 patients, mean age 13.4 years (11.3 – 17.1 years) met inclusion. The most common primary sport was gymnastics in 11 elbows (42%), baseball/softball in 7 elbows (27%), and cheer in 3 elbow (12%). The majority of patients (88%) played at a competitive level. Median symptom duration prior to presentation was 3 months. The most common presenting symptoms were pain (85%) and mechanical symptoms (81%). Sixteen elbows (62%) presented with a >5° loss of elbow extension compared to the contralateral side. The capitellar physis was open in 23 elbows (88%). OCD location was central in 17 elbows (65%) and far lateral in 9 elbow (35%). Mean MRI size of the OCD was 11 mm in coronal width, 12 mm in sagittal length, and 6 mm in depth. Twelve elbows (48%) had a loose body on MRI. The majority of elbows (22, 85%) were treated with a single allograft plug, while 4 elbows had two allograft plugs transplanted. Median OCA size was 12 mm. There were no infections nor arthrofibrosis. Two elbows (8%) had a secondary surgery, both underwent partial synovectomy and chondroplasty at 14- and 16-months following the primary surgery. Postoperative MRIs were obtained in 15 elbows (58%) and had a mean BOGIE (Boston Osteochondral Graft Incorporation in the Elbow) score of 11, thus documenting a high degree of incorporation. Mean follow-up duration was 40 months (range 25 – 60 months). All patients had preoperative, 1-year, and 2-year PROs (Table 1). 21 elbows (81%) had returned to sports at 1-year postoperatively9, and all but 1 patient had returned to sports by 2 years following surgery. Forty-five percent of gymnasts returned to gymnastics, while the remaining pursued different sports. Five of 6 baseball players (83%) returned to baseball. Conclusions: OCAlloT as a treatment for OCD-C is a procedure associated with low rates of complications, excellent graft incorporation, high elbow function and patient satisfaction, and overall high rates of return to sports at 2-years. Return to sports, particularly among gymnasts was less than 50% in this series, which we attribute to a combination of factors, including loss of training and competition time at a critical time for an elite gymnast as well as physician counseling on alternative sports with less stress on the elbow. Continued patient follow-up is ongoing and will be critical to the assessment of this treatment on the mid- and long-term outcomes in these young athletes. [Figure: see text]

The Impact of Total Synovectomy on Blood Loss and Knee Function. A Prospective Randomized Study

"Synovial proliferation is a common intraoperative finding during total knee arthroplasty (TKA) and many studies have proposed synovectomy for the reduction of postoperative pain. We included 180 patients that were split into two groups, one which received a total synovectomy (TS) and the other with partial synovectomy (PS). We measured the amount of intra- and post-operative bleeding as well as perceived pain (using the Visual Analogue Scale) and knee function (using the Knee Society Knee Score) at 4 and 12 weeks. The blood loss during the surgical procedure was 367.77 ± 115.71 mL for TS, while the other group recorded 295.55 ± 106.17 mL (p < 0.05). Regarding postoperative bleeding, the TS group aspirated 533.77 ± 281.65 mL, which was significantly higher than the PS group (404.44 ± 211.55 mL, p < 0.05). No significant differences were recorded between the TS and PS groups regarding pain and knee function at 12 weeks. Total synovectomy demonstrated significantly higher blood loss and lower postoperative hemoglobin levels, even though knee function and pain level did not show improvements. We consider that the decision of performing synovectomy should rely on the clinical indication and, if conditions allow for it, a limited resection should be attempted."

Giant Synovial Chondromatosis of the Shoulder: The Limits of Arthroscopic Treatment and Technical Tips

Synovial chondromatosis (SC) is a rare disease. It is a chondrocytic metaplasia and is characterized by the presence of cartilaginous loose bodies in the involved joint, bursa or tendon sheath, it occurs most often in those aged 30_50 years and 3 times more in males than females, The shoulder is an exceptional location. It causes significant functional disability in young people. The clinical presentation is not specific, and the diagnosis is based on MRI. Confirmation is still anatomopathological. Classically, the mainstay treatment for SC of the shoulder has been open arthrotomy and removal of loose bodies, followed by either complete or partial synovectomy, removing the affected tissue, with recent advances in arthroscopic techniques and methods, arthroscopy becomes the gold standard. We present this case report of a 26-year-old man, who was left-hand dominant, a maintenance technician, amateur football player presented a left shoulder inflammatory pain; ; plain radiography demonstrated multiple calcific densities over the glenohumeral joint , the MRI showed multiple calcified intra-articular loose bodies around the anterior and posterior joint and axillary recess ; At arthroscopy, a large number of loose bodies were observed together with marked synovitis ,it only allowed the removal of small foreign bodies < 1 cm, partial synovectomy was performed with a shaver ; anatomopathological examination confirmed the diagnosis of sc. the extraction of giant fragments >2 cm was impossible so it was subsequently removed by open surgery. This was carried out one month later using a delto-pectoral approach: all foreign bodies > 1 cm were successfully extracted. We report this case report in order to review the role of shoulder arthroscopy and magnetic resonance imaging (MRI) in diagnosis and treatment and to highlight the operative difficulties, technical tips of arthroscopic extraction of giant Synovial chondromatosis of the shoulder.

Arthroscopic management of recurrent synovial chondromatosis of the hip: a case report.

Here the authors report a case of eighteen years lady with recurrent hip synovial chondromatosis who was treated previously with hip arthrotomy and loose bodies removal and now she underwent arthroscopic loose bodies removal with partial synovectomy. In comparison to arthrotomy of the hip, arthroscopic management is a minimally invasive surgery that is associated with decreased postoperative pain, earlier improvement in range of motion, a shorter course of rehabilitation, and overall lower morbidity. Thus, the authors recommend arthroscopic removal of the loose bodies and partial synovectomy for the management of synovial chondromatosis of the hip.

Carpal Tunnel Syndrome and Trigger Digit: An Early Symptom of Cardial Amyloidosis

Abstract Background Amyloidosis is a disease with misfolded protein deposits. The subform transthyretin amyloidosis (ATTR) presents with heart failure, atrial fibrillation and bundle branch block, often requiring pacing. Soft tissue deposits may occur, causing trigger digit (TD) and carpal tunnel syndrome (CTS). These may be an initial symptom of systemic amyloidosis with cardiac manifestation, they precede cardiac amyloidosis on average 5-9 years. Studies showed positivity of up to 22.5% for ATTR in tenosynovial biopsies in CTS-patients identified by a screening algorithm. ATTR is found in around 25% of autopsies at 80 years and older, with underestimated prevalence in the general population. Aims Early detection is crucial in treating systemic amyloidosis. Therefore, biopsies taken during carpal tunnel release (CTR) and trigger release (TR) can contribute significantly to its diagnosis. Methods Patients admitted in 2022 to our hospital were examined prospectively and biopsied if macroscopic intraoperative synovial hyperplasia was present. Histologic examination was done with Congo red staining and immunohistologic examination for ATTR. Patients tested positive for ATTR were offered a cardiologic follow-up. Results 118 patients (63 CTS, 55 TD) were included in the study, 40 (34%) underwent partial synovectomy. Of these, 3 patients (7.5%) were positive for ATTR. 1 patient had an unremarkable cardiologic examination, 1 patient declined, 1 patient is pending. Conclusions Early detection of amyloidosis by CTR and TR is a topic of increasing relevance. In our study, the positivity rate was lower than in others. However, there was different patient selection, e.g., according to macroscopic findings instead of a screening algorithm. The observation period is insufficient to record any cardiac results; a follow-up in 5-10 years would be appropriate. Current therapy for amyloidosis aims to delay the disease progress by preventing deposit formation, with no therapy degrading pre-existing deposits. Thus, early detection is crucial for disease outcome and justifies additional screening cost.

The German Arthroscopy Registry DART: what has happened after 5 years?

PurposeThe German Arthroscopy Registry (DART) has been initiated in 2017 with the aim to collect real-life data of patients undergoing knee, shoulder, hip or ankle surgery. The purpose of this study was to present an overview of the current status and the collected data thus far.MethodsData entered between 11/2017 and 01/2022 were analyzed. The number of cases (each case is defined as a single operation with or without concomitant procedures) entered for each joint, follow-up rates and trends between different age groups (18–29 years, 30–44 years, 45–64 years, ≥ 65 years) and across genders, and quality of life improvement (pre- vs. 1 year postoperative EQ visual analogue scale [EQ-VAS]) for frequently performed procedures (medial meniscus repair [MMR] vs. rotator cuff repair [RCR] vs. microfracturing of the talus [MFX-T]) were investigated.ResultsOverall, 6651 cases were entered into DART, forming three distinct modules classified by joint (5370 knee, 1053 shoulder and 228 ankle cases). The most commonly entered procedures were: knee: partial medial meniscectomy (n = 2089), chondroplasty (n = 1389), anterior cruicate ligament reconstruction with hamstring autograft (n = 880); shoulder: sub acromial decompression (n = 631), bursectomy (n = 385), RCR (n = 359); ankle: partial synovectomy (n = 117), tibial osteophyte resection (n = 72), loose body removal (n = 48). In the knee and shoulder modules, middle-aged patients were the predominant age group, whereas in the ankle module, the youngest age group was the most frequent one. The two oldest age groups had the highest 1-year follow-up rates across all modules. In the knee and shoulder module, 1-year follow-up rates were higher in female patients, whereas follow-up rates were higher in male patients in the ankle module. From pre- to 1-year postoperative, MFX-T (EQ-VAS: 50.0 [25–75% interquartile range: 31.8–71.5] to 75.0 [54.3–84.3]; ∆ + 25.0) led to a comparably larger improvement in quality of life than did MMR (EQ-VAS: 70.0 [50.0–80.0] to 85.0 [70.0–94.0]; ∆ + 15.0) or RCR (EQ-VAS: 67.0 [50.0–80.0] to 85.0 [70.0–95.0]; ∆ + 18.0).ConclusionDART has been sufficiently established and collects high-quality patient-related data with satisfactory follow-up allowing for a comprehensive analysis of the collected data. The current focus lies on improving patient enrolment and follow-up rates as well as initiating the hip module.

Assessment of the efficiency of arthroscopic laser dual-mode synovectomy in patients with chronic synovitis of the knee joint

BACKGROUND: Osteoarthritis (OA) of the knee joint is a common disease and a significant medical, social, and economic problem. Synovitis can be revealed at all stages of ОА, contributing to the progression of cartilage damage, increased pain, and impaired joint function. In patients with OA, the morphological pattern of the synovial membrane structure has characteristic features, such as hyperplasia, sublimating fibrosis, and stromal vascularization. Laser radiation is widely used in medicine. Exposure of two working wavelengths (0.97 m and 1.56 m) to the synovial membrane may lead to good results in the treatment of synovitis. AIM: This study aimed to improve treatment outcomes in patients with chronic synovitis of the knee joint by applying radiation of two different wavelengths. MATERIALS AND METHODS: Treatment outcomes of 50 patients with chronic synovitis of the knee joint, aged 23 to 67 years, with stages IIIV gonarthrosis according to the KellgrenLawrence classification, were prospectively analyzed. All patients underwent arthroscopic sanation and laser partial synovectomy using LSP-IRE-Polus apparatus (OOO NTO IRE-Polus, Russia), with a wavelength of 0.97 m (pulse 100 ms, pause 50 ms) in a pulsed-periodic mode and 1.56 m with a power of 5 W in a continuous mode. Surveys were conducted preoperatively and at 3, 6, and 12 months postoperatively using the following scales and questionnaires: Visual Analog Pain Scale (VAS), Lequesne index, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS: The mean age (Ms) of the study subjects, body mass index, and the duration of synovitis were 45.3213.1, 28.634.72 kg/m2, and 2.261.91 years, respectively. Statistically significant improvements in the VAS, WOMAC, Lequesne, and KOOS scales were observed three months after surgery, whereas much more better results were obtained at six months and remained the same within 12 months after surgery (p 0.05). CONCLUSIONS: The results suggest that the proposed technique could be introduced into clinical practice.

Synovial chondromatosis: a rare cause of knee pain and swelling

<p>Synovial chondromatosis (SC) is a rare, benign, metaplastic, monoarticular disorder of synovial membrane and bursae of large joints. It commonly affects the large joints such as the knee, hips, wrist, ankle and shoulder. Here we report a case of SC of right knee in a 60-year-old female presenting with chief complaints of pain, swelling, restriction of movement in right knee for 1 year after a fall at home. X-ray of right knee revealed multiple calcified loose bodies. The final diagnosis was established by correlating radiologic findings with the histopathology of the excised specimen. Patient was successfully treated by open partial synovectomy of knee using anterior approaches in a single step procedure.</p>

Knee Preservation Techniques for Severe Synovial Osteochondromatosis in End-Stage Osteoarthritic Knee Using High Tibia Osteotomies, Cartilage Restoration Procedure, and Biologics; A Case Report in Bilateral Knees

Synovial osteochondromatosis can occur idiopathic or secondary to osteoarthritis. While joint replacement surgery has shown promising results for end-stage osteoarthritis, it isn’t always the answer for certain individual. In young athletic individual, the treatment should be patient specific, with consideration for return to sports activities. We present a 48-year-old ex-national professional football player with significant osteoarthritis and severe synovial osteochondromatosis. After discussion with the patient, we decide that knee preservation is suitable for him. Surgical treatments that are considered the best option are High Tibial Ostetomies, extraction of the loose bodies, partial synovectomy, and microfracture. Those procedures were performed in 8 months interval for each knee. The patient received intra-articular injection of cultured Mesenchymal Stem Cells (MSCs) with hyaluronic acid for 4 weeks after surgery. In a 34-month follow-up for right knee and 26-month follow-up for left knee, the patient regained significantly higher Knee injury and Osteoarthritis Outcome Score (KOOS) compare to before surgery (94 vs. 47). Radiologic examination also reveals the improvement of both knees joint space.

Pediatric septic arthritis of the hip: the benefit of hip arthroscopy by extracapsular (outside-in) approach

Background:Pediatric septic arthritis of the hip is a surgical emergency. Facing a hip flexum and fever, surgeons can use comparative ultrasound to confirm the diagnosis and to establish the surgical indication. While needle aspiration-irrigation is a simple and quick method, it gives rise to a high rate of recurrence. The purpose of our study was to demonstrate that hip arthroscopy by extracapsular approach is an effective and accessible alternative applicable in emergency situations.Methods:This is a report of 2 cases (7 years-135 cm; 13 years-143 cm) of needle aspiration-irrigation failure subsequently treated by hip arthroscopy. The X-ray and arthroscopy-assisted extracapsular technique was performed on a conventional orthopedic table, using a 30 degree arthroscope and a 3.5mm diameter motorized knife. Minimally invasive anterior longitudinal capsulotomy was performed by 2 anterolateral approaches via the proximal and distal tensor Fasciae Latae muscle, without dedicated instrumentation, followed by sampling, irrigation, removal of false membranes, synovial biopsies, partial synovectomy, cartilage assessment of the central then peripheral compartment and placement of a drainage.Results:In both cases, effusion completely disappeared and the inflammatory process gradually normalized with antibiotic therapy without any repeat procedure or complications related to the approach. Weight bearing was resumed in 3 weeks. Postoperatively, in 6 months and 15 months respectively, after resumption of sports activities hip examination was painless and no damage was noted on x-rays in either case.Conclusion:In our experience, hip arthroscopy by extracapsular approach can effectively address cases of failed needle aspiration-irrigation in pediatric septic arthritis of the hip. It could be provided as first-line emergency treatment in the event of purulent septic arthritis or late management, as a replacement for arthrotomy.

English

English

Knee septic arthritis caused by \u03b1-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report

BackgroundArthroscopic partial meniscectomy is a common procedure in orthopedic practice. Infections are uncommon complications of this procedure with an incidence rate of 0,01% - 3,4%. Staphylococcus spp are the predominant causative agents in such cases. We present a case of knee septic arthritis caused by α-hemolytic Streptococcus.Case presentationA 22-year-old woman diagnosed with obesity (body mass index [BMI] 35 kg/m2) but with no other major comorbidities underwent an arthroscopic selective meniscectomy with administration of intravenous cefazolin for antibiotic prophylaxis. After an uneventful period of 2 months, the patient returned with pain, fever and a discharging sinus at the site of anterolateral arthroscopic portal. Blood tests and magnetic resonance imaging revealed osteomyelitis involving the tibial plate. Cultures of synovial fluid obtained from the knee and a pharyngeal swab yielded α-hemolytic Streptococcus. Five days later, the patient underwent arthroscopic debridement with partial synovectomy. Intraoperative specimens yielded α-hemolytic Streptococcus. The patient received intravenous piperacillin/tazobactam, followed by an associative regimen of amoxicillin and clindamycin with clinical, laboratory and instrumental evidence of symptom resolution.ConclusionThe incidence of knee septic arthritis after arthroscopic partial meniscectomy is 0.01–3.4%. This infection is usually caused by Staphylococcus spp. and in rare cases by commensal bacteria, such as α-hemolytic streptococci, secondary to transient bacteremia. Screening of the colonized area is important to prevent possible transient bacteremia. Diagnosis is based on isolation of the causative organisms from synovial fluid cultures, and treatment comprises arthroscopic debridement with individualized systemic antibiotic therapy based on the results of an antibiogram.

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>

Arthroscopic Management of Synovial Chondromatosis of the Temporomandibular Joint. Case Series and Systematic Review.

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 arthroscopyfor the treatment of SC ofthe temporomandibular joint (TMJ). 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. Pain, which was the main symptom in our patients, and maximum mouth opening both improved significantly after surgicaltreatment. 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. 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 3mm or without extra-articular extension.

Results and recurrence of pigmented villonodular synovitis of the ankle: does diffuse PVNS with extra-articular extension tend to recur more often?

The aim of this study was to provide the outcomes and to analyze the recurrence of Pigmented Villonodular Synovitis (PVNS) of the ankle joint treated by surgical synovectomy. Thirty-one PVNS cases of the ankle, including 5 localized PVNS cases and 26 diffuse PVNS cases, were treated in our institute between 2004 and 2015. The median age was 35 (range 18-63) years. The 5 localized PVNS cases were treated with partial synovectomy (group I); 10 diffuse PVNS cases limited to intra-articular synovium received arthroscopic comprehensive synovectomy (group II); and 16 cases with diffuse PVNS spreading to extra-articular tendon sheaths underwent combined arthroscopic and open synovectomy (group III). Adjuvant radiotherapy was provided in groups II and III. The American Orthopaedic Foot and Ankle Society (AOFAS) score and subjective grading of procedure were used to evaluate the results. Twenty-seven patients were followed with a median of 54 (range 15-108) months. In the three groups, the average AOFAS score improved from 75 (in all three groups) points preoperatively to 100 (group I), 97 (group II), and 90 points (group III) postoperatively. The rate of good-to-excellent result was 100% in group I and II and 73.3% in group III. Only in group III, recurrence occurred in five cases. Diffuse PVNS of the ankle can be successfully managed with surgical synovectomy and adjuvant radiotherapy. Radiotherapy is not needed for localized PVNS. The recurrence rate in PVNS patients with extra-articular extension is higher. IV.

Prognosis of Advanced Tenosynovial Giant Cell Tumor of the Knee Diagnosed During Total Knee Arthroplasty

BackgroundTenosynovial giant cell tumor (TGCT) is a relatively rare disease often misdiagnosed as osteoarthritis. Synovectomy or arthroplasty is the recommended treatment option, but recurrence is common after surgery. This study aimed to determine the prognosis of patients with advanced TGCT that was diagnosed incidentally during total knee arthroplasty (TKA) for osteoarthritis and treated by synovectomy. MethodsFrom January 2008 to July 2011, TGCT was diagnosed incidentally in 10 patients (a total of 11 individual knees) undergoing posterior-stabilized TKA for an initial diagnosis of osteoarthritis. TGCT was confirmed by histopathology of biopsy specimens. Partial synovectomy was performed for localized-type TGCT (3 knees, 3 patients) and total synovectomy for diffuse-type TGCT (8 knees, 7 patients). ResultsAll patients were female with a mean age of 61.7 ± 6.6 (range 50-70) years. No postoperative infection, nerve injury, or deep venous thrombosis occurred. All patients were followed up for a mean period of 60.9 ± 6.6 (39-83) months, and no recurrence of TGCT occurred. X-ray imaging showed no apparent radiolucent lines around the prosthesis, and no prosthetic loosening, subsidence, or osteolysis. The joints were stable, with a significantly improved range of motion following surgery (109.5° ± 8.8° vs 80.5° ± 16.8°, P < .01). The Knee Society scores for knee joint (90.0 ± 4.1 vs 40.5 ± 8.1) and knee function (81.8 ± 7.5 vs 35.0 ± 13.8) were both significantly improved after surgery (P < .01). ConclusionInactive TGCT could not be diagnosed preoperatively. TKA combined with synovectomy is effective in the treatment of advanced TGCT with degenerative lesions.

Arthroscopic Treatment for Primary Septic Arthritis of the Hip in Adults.

Purpose. Primary septic arthritis is a rare differential diagnosis of acute hip pain in adults. Inspired by the success of all-arthroscopic treatment in pediatric patients, we developed a diagnostic and surgical pathway for our adult patients. Methods. Seven patients, average age 44 ± 13.7 years with acute hip pain since 4.4 ± 2.9 days in the average, were included. Septic arthritis was confirmed by joint aspiration and dissemination was excluded by MRI and standard radiographs. Surgical treatment consisted of immediate arthroscopic lavage using 4 portals for debridement, high-volume irrigation, partial synovectomy, and drainage. Results. Patients were treated in hospital for 12.4 ± 3.1 days (range 7–16 days). WBC and CRP returned to physiological levels. During the mean follow-up of 26.4 ± 19.4 months (range 13–66 months) no patient showed recurrence of infection. The 5 patients with an unimpaired hip joint prior to the infection had a mean modified Harris Hip Score of 94 ± 5.6 points (range 91–100) at final follow-up. Conclusions. Arthroscopic therapy using a minimally invasive approach with low perioperative morbidity for the treatment of primary septic arthritis of the adult hip is able to restore normal hip function in acute cases without dissemination of the infection. Level of Evidence. IV.

Benefits of radial head excision in patients with haemophilia: mid-term functional results.

Recurrent haemarthrosis in haemophilic patients result with arthropathy of the radiocapitellar joint and blockage of the forearm rotation. The aim of this study is to evaluate the mid-term results of radial head excision with partial synovectomy in severe haemophilic patients retrospectively. Persistent pain and decreased forearm rotation were the main indications for radial head excision. Between 2002 and 2013, radial head excisions were performed for 14 elbows of 14 patients. Eleven patients were haemophilia A, whereas two patients were haemophilia B patients and the remaining one had von Willebrand (Type 3) disease. The mean age of the patients was 29 at the time of the surgery. The mean follow-up was 51 (12-155) months. VAS (visual analogue score) for pain, forearm rotation, qDASH and MEPS (Mayo Elbow Performance Score) were used as the primary outcome parameters. The mean VAS decreased significantly from 6.5 preoperatively to 2.2 at the final follow-up (P = 0.0003). The mean forearm rotation increased from 40° to 115° respectively (P = 0.0007). In two patients, efficacious rotation increase was not achieved due to distal radioulnar joint problems. The mean qDASH score and MEPS were 18.1 and 87.5 at the latest follow-up, respectively, where four patients had excellent and 10 patients had good results. Radial head excision is a safe and effective procedure for haemophiliac patients with radiocapitellar arthropathy and decreased forearm rotation. Distal radioulnar joint should be evaluated preoperatively which may impair the results.

Biceps Tenoscopy in Arthroscopic Treatment of Primary Synovial Chondromatosis of the Shoulder

Primary synovial chondromatosis (PSC) of the shoulder is a rare condition and usually necessitates operative therapy. Arthroscopic partial synovectomy with removal of loose osteochondromas may be regarded as the current surgical treatment of choice. However, involvement of the biceps tendon sheath (BTS) occurs in almost half of the patients and required additional open surgery in all previously reported cases. We successfully performed tenoscopy of the BTS and long head of the biceps tendon during arthroscopic treatment of PSC in a 26-year-old male competitive wrestler. Biceps tenoscopy enabled minimally invasive partial (teno)synovectomy and removal of all osteochondromas within the BTS. The symptoms of PSC fully subsided within 2 postoperative weeks. There were no functional restrictions at the 3-month follow-up examination. These preliminary results support the feasibility, safety, and efficacy of biceps tenoscopy as a complement in arthroscopic treatment of PSC of the shoulder, dispensing with the need for additional open surgery. The spectrum of indications for biceps tenoscopy has still to be defined. Conceivable indications are proposed. This first report of a diagnostic and interventional biceps tenoscopy entails a detailed step-by-step description of the surgical technique.