Introduction:
Fourteen cases of
After knee replacement, therapy resistant, chronic synovitis is common and leads to effusion and pain. A cohort of 55 patients with 57 knee replacements and chronic synovitis underwent radiosynoviorthesis. In summary, 101 joints were treated using 182±9 MBq of 90Y-citrate. The number of radiosynoviorthesis ranged from 1 to 4 (53%, 21%, 23%, and 4%). Every patient received a 99mTc-MDP scintigraphy before and three months after every radiosynoviorthesis. Follow-up ranged from 5.7 to 86.7 months. For qualitative analysis, an four steps scoring was used (0 = no response or worsening, 1 = slight, 2 = good, 3 = excellent response). For quantification, the uptake was determined within the 99mTc-MDP scintigraphy soft tissue phase before and after therapy. At the end of long-term follow-up 27% of patients have an excellent, 24% good, 30% slight and 20% no response. The duration of response was 7.5±8.3 months (maximum 27 months). In repeated treatment, the effect after the first therapy was lesser than in patients who received a single treatment in total. However, three months after the last radiosynoviorthesis, patients with repeated treatment showed a similar effectiveness than single treated patients. At the end of long-term follow-up, patients with repeated radiosynoviorthesis had a higher effectiveness at similar duration response. In the 99mTc-MDP scan 65% of patients showed a reduction of uptake. When comparing subjective and objective response 78% of patients showed a concordance in both, symptoms and scintigraphy. Pilot histological analysis revealed that the synovitis is triggered by small plastic particles. Radiosynoviorthesis is effective in patients with knee replacement and chronic synovitis. It shows good subjective and objective response rates and long response duration. Repeated treatment leads to a stronger long-time response. The chronic synovitis is caused by plastic particles, which result from the abrasion of the polymeric inlay of endoprothesis.
Introduction:. Pigmented Villonodular
Purpose: Pigmented Villonodular
The opposable thumb is one of the defining characteristics of human anatomy and is involved in most activities of daily life. Lack of optimal thumb motion results in pain, weakness, and decrease in quality of life. First carpometacarpal (CMC1) osteoarthritis (OA) is one of the most common sites of OA. Current clinical diagnosis and monitoring of CMC1 OA disease are primarily aided by X-ray radiography; however, many studies have reported discrepancies between radiographic evidence of CMC1 OA and patient-related outcomes of pain and disability. Radiographs lack soft-tissue contrast and are insufficient for the detection of early characteristics of OA such as synovitis, which play a key role in CMC OA disease progression. Magnetic resonance imaging (MRI) and two-dimensional ultrasound (2D-US) are alternative options that are excellent for imaging soft tissue pathology. However, MRI has high operating costs and long wait-times, while 2D-US is highly operator dependent and provides 2D images of 3D anatomical structures. Three-dimensional ultrasound imaging may be an option to address the clinical need for a rapid and safe point of care imaging device. The purpose of this research project is to validate the use of mechanically translated 3D-US in CMC OA patients to assess the measurement capabilities of the device in a clinically diverse population in comparison to MRI. Four CMC1-OA patients were scanned using the 3D-US device, which was attached to a Canon Aplio i700 US machine with a 14L5 linear transducer with a 10MHz operating frequency and 58mm. Complimentary MR images were acquired using a 3.0 T MRI system and LT 3D coronal photon dense cube fat suppression sequence was used. The volume of the synovium was segmented from both 3D-US and MR images by two raters and the measured volumes were compared to find volume percent differences. Paired sample t-test were used to determine any statistically significant differences between the volumetric measurements observed by the raters and in the measurements found using MRI vs. 3D-US. Interclass Correlation Coefficients were used to determine inter- and intra-rater reliability. The mean volume percent difference observed between the two raters for the 3D-US and MRI acquired synovial volumes was 1.77% and 4.76%, respectively. The smallest percent difference in volume found between raters was 0.91% and was from an MR image. A paired sample t-test demonstrated that there was no significant difference between the volumetric values observed between MRI and 3D-US. ICC values of 0.99 and 0.98 for 3D-US and MRI respectively, indicate that there was excellent inter-rater reliability between the two raters. A novel application of a 3D-US acquisition device was evaluated using a CMC OA patient population to determine its clinical feasibility and measurement capabilities in comparison to MRI. As this device is compatible with any commercially available ultrasound machine, it increases its accessibility and ease of use, while proving a method for overcoming some of the limitations associated with radiography, MRI, and 2DUS. 3DUS has the potential to provide clinicians with a tool to quantitatively measure and monitor OA progression at the patient's bedside.
Background: The surgical treatment of extensive diffuse Pigmented Villonodular
Introduction: Diffused
Around 5–15% of patients will experience chronic postoperative pain after total knee replacement (TKR) surgery but the source of the pain is unknown. The aim of this study was to assesses patients six months after TKR using magnetic resonance imaging (MRI) of the knee, pain sensory profiles and assessments of pain catastrophizing thoughts. Forty-six patients had complete postoperative data and were included. MRI findings were scored according to the MRI Osteoarthritis Knee Score (MOAKS) recommendation for Hoffa synovitis, effusion size and bone marrow lesions. Pain sensory profiles included the assessment of pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM). Pain catastrophizing was assessed using the pain catastrophizing scale (PCS). Clinical pain was evaluated using a visual analog scale (VAS, 0–10cm) and groups of moderate-to-severe (VAS>3) and non-to-mild postoperative pain (VAS≤3) were identified.Abstract
Background
Methods
A patient in his thirties developed synovitis with grade 4 chondrolysis and a stiff knee with a fixed flexion deformity between three and six years following PLC and PCL reconstruction using LARS (Ligament Augmentation and Reconstruction System, Corin). There was histologic evidence of foreign body reaction, the knee was painful, swollen and stiff. We did not use any further LARS ligaments for soft tissue reconstructions of the kneein our practice. We commenced a recall programme for all 83 patients patients who underwent a soft tissue knee reconstruction using LARS. Of those contacted, 41 replied (49%) and 16 patients had symptoms (19%) and were investigated further with XRay, MRI and arthroscopy as indicated. We discovered a total of five patients had histologically proven synovitis with foreign body reactions (6%), three of whom had life-changing symptomatic pain, swelling and stiffness with degenerate changes (3.6%). These patients had undergone various reconstructions, including a) PLC only, b) ACL and PCL, c) PCL and PLC and d) ACL, PCL and PLC. A further single case of massive bone cyst formation was noted, following PCL reconstruction using LARS (1.2%).
The history of synoviorthesis in haemophiliacs and recent studies has shown that it is a safe procedure and that the results are similar to those seen following open or arthroscopic synovectomy. Colloidal Yt 90 silicate is a beta emitter with a half life of 2.7 days and a mean depth of penetrating soft tissue of 4mm. We evaluate the outcome of Yt 90 injection in patients with chronic haemophilic synovitis of the knee. A retrospective study was done from 1998–2006 of 35 patients with 44 joint injections. Indications were repeated bleeds (4 episodes); chronic synovitis. The age range was 4–27 years. A dose of 2–5 mCu was injected intra-articularly using a sterile technique and local anaesthetic, after an intravenous factor V111 infusion (5 patients had antibodies) and initial joint lavage. The knees were immobilized in above knee backslabs for 2/7. Patient follow up of up to 8 years was conducted. Patients were assessed for pain relief, range of movement, repeated bleeds, cost saving, quality of life and progression to haemophilic arthropathy. Pain relief of 2 or more points on VAS was reported by 30 patients (85.7%). 18 Patients reported a decrease in bleeding frequency (51.4%). 11 Patients had no further bleeds (31.4%). We conclude that there was a significant cost saving as a result of the decreased need for the use of cryo-precipitate. Two patients experienced localised areas of necrosis from radio colloid extravasation. These wounds healed after 3 weeks of local dressings. 60% of joints had and increased range of movement. 92% reported improved quality of life. We have found yttrium synoviorthesis to be an inexpensive, relatively simple and painless technique for treating chronic haemophilic synovitis. The majority of patients were satisfied, experiencing pain relief, increased range of motion and significant monetary saving from reduced cryoprecipitate use.
“Subacute Synovities of the Hip”, which runs a more fluctuant clinical progress and slower response to treatment than those of acute transient synovitis, is always posing diagnostic and management challenge in children presented with acute hip pain. This study aims to identify the special features of this distinct entity, and the important diagnostic parameters in differentiation of acute transient synovitis, subacute arthritis and also septic arthritis in children presented with acute painful pain. From 1985–1999, 427 children have been admitted into our centre with subsequent diagnosis of acute transient synovitis, subacute synovitis &
septic arthritis. 320 cases with full records are available for review, with 270 cases 85%) having acute transient synovitis, 35 cases (10%) of subacute arthritis and 15 cases (5%) of septic arthritis. Statistical results showed that patient having subacute arthritis different significantly from those with acute transient synovitis in terms of age of presentation &
duration of symptoms before hospitalization. Moreover, patient having transient synovitis significantly different from those with septic arthritis in terms of temperature on admission, ESR and White Cell Count.