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Schindler M, Puchner S, Reinhard J, Leiss F, Windhager R, Lass R. Recurrence-Free Survival after Synovectomy and Subsequent Radiosynoviorthesis in Patients with Synovitis of the Knee-A Retrospective Data Analysis. J Clin Med 2024; 13:601. [PMID: 38276107 PMCID: PMC10816869 DOI: 10.3390/jcm13020601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Persistent knee synovitis leads to joint discomfort, incapacitating inflammation, and functional limitations. The conventional approach has involved surgical procedures to eliminate the actively inflamed synovial membrane. This study aims to investigate the recurrence-free survival and functional outcome after synovectomy and subsequent radiosynoviorthesis (RSO) in patients with knee synovitis. METHODS Thirty-seven knees diagnosed with pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), and peripheral spondyloarthritis underwent synovectomy and subsequent RSO between May 2005 and October 2016. The mean age was 34.9 ± 15.1 years, and the mean follow-up period was 84 ± 36.4 months. Clinical outcomes were assessed using the Oxford Knee Score and the presence of swelling and pain at the last follow-up. Recurrence-free survival denotes the duration from synovectomy to surgical re-synovectomy. RESULTS In general, twelve knees underwent re-synovectomy after a mean follow-up of 34.8 ± 24.9 months. The recurrence-free survival was 83.8% at two years, 71.3% at five years, and 61.7% at ten years. The subgroup analysis revealed recurrence-free survival at two years in 63.6% of patients with PVNS, 86.7% of those with RA, and 100% of individuals with peripheral spondyloarthritis. CONCLUSIONS This study demonstrates that combined therapy for synovitis is an effective approach, significantly improving clinical outcomes.
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Affiliation(s)
- Melanie Schindler
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (R.W.); (R.L.)
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Stephan Puchner
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (R.W.); (R.L.)
| | - Jan Reinhard
- Department of Orthopedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany; (J.R.); (F.L.)
| | - Franziska Leiss
- Department of Orthopedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Germany; (J.R.); (F.L.)
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (R.W.); (R.L.)
| | - Richard Lass
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (R.W.); (R.L.)
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Li M, Shi X, Yin S, Zhang L, Wu P, Liao T, Jie L, Wang P. Should synovectomy be performed during total knee arthroplasty for knee osteoarthritis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27820. [PMID: 34797309 PMCID: PMC8601306 DOI: 10.1097/md.0000000000027820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To evaluate the effect of synovectomy performed during primary total knee arthroplasty for knee osteoarthritis on patients' postoperative pain and knee function. METHODS We will search the following electronic databases from inception to June 2021, including PubMed, EMBASE, Web of Science, the Cochrane Library, the China National Knowledge Infrastructure, the Chinese Scientific Journals Database, the Wanfang database, and the Chinese Biomedicine Database. Eligible references will be all randomized controlled trials of initial total knee arthroplasty for primary knee osteoarthritis with or without synovectomy. Two reviewers will independently extract the data. Reviewer Manager 5.3 software will be used for statistical analysis. RESULT It will provide results on the short- and long-term efficacy and safety of synovectomy in total knee arthroplasty by various comprehensive assessments. CONCLUSION This study will provide solid evidence on whether and when synovectomy treatment should be performed during total knee arthroplasty.
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Affiliation(s)
- Mingchao Li
- Department of Orthopaedic Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine; 155 Hanzhong Road, Nanjing, Jiangsu, China
- Department of Orthopaedic Surgery, The Third People's Hospital of Kunshan, 615 Zizhu Road, Kunshan, Suzhou, Jiangsu, China
| | - Xiaoqing Shi
- Department of Orthopaedic Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine; 155 Hanzhong Road, Nanjing, Jiangsu, China
| | - Songjiang Yin
- Department of Orthopaedic Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine; 155 Hanzhong Road, Nanjing, Jiangsu, China
| | - Li Zhang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine; 155 Hanzhong Road, Nanjing, Jiangsu, China
| | - Peng Wu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine; 155 Hanzhong Road, Nanjing, Jiangsu, China
| | - Taiyang Liao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine; 155 Hanzhong Road, Nanjing, Jiangsu, China
| | - Lishi Jie
- Department of Orthopaedic Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine; 155 Hanzhong Road, Nanjing, Jiangsu, China
| | - Peimin Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine; 155 Hanzhong Road, Nanjing, Jiangsu, China
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Lassen J, Baron R. [Rheumatic diseases and neuropathic pain : Diagnosis and treatment]. Z Rheumatol 2020; 80:226-233. [PMID: 33355701 DOI: 10.1007/s00393-020-00950-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/29/2022]
Abstract
Pain is a leading symptom in inflammatory rheumatic diseases. For a long time it has been assumed that this pain is of nociceptive origin; however, in about one fifth of all patients the pain remains despite successful anti-inflammatory treatment and is not typically described as nociceptive by those affected. Recent studies indicate that some patients with rheumatoid arthritis (RA) experience pain with a neuropathic pain component. The treatment of neuropathic pain with damage to the somatosensory system differs markedly from the treatment of nociceptive pain in which the pain processing system is intact. Thus, the recognition and, above all, the more precise differentiation of the pain symptoms of affected patients make a decisive contribution to a successful treatment. With the help of a few points in the history and a physical examination, the assumption of the diagnosis neuropathic pain can often be rejected or substantiated. Pain with a neuropathic component does not adequately respond to typical analgesics. Instead, the high efficacy of co-analgesics, such as anticonvulsants and antidepressants, has been repeatedly proven.
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Affiliation(s)
- J Lassen
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Deutschland
| | - R Baron
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Deutschland.
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Hammer HB, Michelsen B, Provan SA, Sexton J, Lampa J, Uhlig T, Kvien TK. Tender Joint Count and Inflammatory Activity in Patients With Established Rheumatoid Arthritis: Results From a Longitudinal Study. Arthritis Care Res (Hoboken) 2019; 72:27-35. [DOI: 10.1002/acr.23815] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | - Brigitte Michelsen
- Diakonhjemmet Hospital, Oslo, Norway, and Hospital of Southern Norway Trust Kristiansand Norway
| | | | | | - Jon Lampa
- Karolinska InstituteKarolinska University Hospital Stockholm Sweden
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O'Shaughnessy MA, Kannas S, Ernste F, Rizzo M. Team Approach: Role of Medical and Surgical Management in Rheumatoid Arthritis of the Hand and Wrist. JBJS Rev 2019; 7:e10. [PMID: 31460989 DOI: 10.2106/jbjs.rvw.18.00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Maureen A O'Shaughnessy
- Departments of Orthopedic Surgery (M.A.O. and M.R.), Physical Medicine and Rehabilitation (S.K.), and Rheumatology (F.E.), Mayo Clinic, Rochester, Minnesota
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Abstract
The knee joint is often involved in rheumatoid arthritis. Despite ever-improving medical antirheumatic therapies, surgical treatment continues to play an important role in optimal multidisciplinary care. The aim of the present work is to process current orthopedic surgical therapy procedures on the knee joint according to disease stage. In the early phase, joint-preserving arthroscopic procedures for synovectomy are used. In advanced joint destruction, joint function can be restored by total knee arthroplasty. Of central importance for optimal patient care are individual treatment and good interdisciplinary coordination of all involved specialist groups.
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Cook AD, Christensen AD, Tewari D, McMahon SB, Hamilton JA. Immune Cytokines and Their Receptors in Inflammatory Pain. Trends Immunol 2018; 39:240-255. [DOI: 10.1016/j.it.2017.12.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 01/23/2023]
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Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist.
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Yoon HM, Jo YH, Lee BG. Surgical Treatment for the Shoulder Joint in Rheumatoid Patients. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.3.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Murakami K, Nakagawa H, Nishimura K, Matsuo S. Changes in peptidergic fiber density in the synovium of mice with collagenase-induced acute arthritis. Can J Physiol Pharmacol 2015; 93:435-41. [PMID: 25909759 DOI: 10.1139/cjpp-2014-0446] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effect of acute osteoarthritis (OA) on peripheral nerve fibers (NFs) in synovial tissue, and their association with histological changes were investigated in collagenase-induced OA mice. Collagenase (10 U in 5 μL saline) was injected into the right knee, and the same volume of saline was injected into the left knee as the control. Mice were sacrificed 1, 2, 3, and 4 weeks after the collagenase injection. Histopathological changes in the knee joints were evaluated. The numbers of protein gene product (PGP) 9.5-, calcitonin-gene-related peptide (CGRP)-, and substance P (SP)-positive NFs in the synovial tissue were determined, and their densities in the tissue were calculated. The densities of PGP 9.5- and CGRP-positive NFs in the synovium were drastically decreased 1 week after the collagenase injection. However, by week 4, the density of PGP 9.5- and CGRP-positive NFs had recovered to 84% and 79% of their normal levels, respectively. Despite the poor correlation between the synovitis score and the density of CGRP- or SP-positive NFs in the synovium, the ossification rate of chondrophytes in chondro/osteophyte lesions correlated strongly with the density of CGRP-positive NFs (R = 0.855). These results suggest that the ossification of chondrophytes occurred in parallel with the increase in CGRP-positive fiber density in the synovium during the acute phase of collagenase-induced OA.
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Affiliation(s)
- Kohei Murakami
- Laboratory of Toxicology, Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-ourai-kita, Izumisano-shi, Osaka 598-8531, Japan., Department of Veterinary Clinical Pathobiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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Analysis of clinical factors related to the efficacy of shoulder arthroscopic synovectomy plus capsular release in patients with rheumatoid arthritis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:451-5. [PMID: 25537932 DOI: 10.1007/s00590-014-1570-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/25/2014] [Indexed: 10/24/2022]
Abstract
Shoulder synovectomy is a well-known surgical treatment for rheumatoid arthritis. However, synovectomy alone is insufficient for improving range of motion clinically. We investigated the clinical factors related to the efficacy of shoulder synovectomy performed with capsular release in patients with rheumatoid arthritis. Fifty-four shoulders of 54 patients (12 males, 42 females; mean age 53.3 years) with rheumatoid arthritis were treated by synovectomy plus capsular release. The patients had a mean disease duration of 8.33 years, a mean follow-up period of 5.02 years, and 66.7% received biological treatment. The disease activity score 28 using C-reactive protein, range of motion of the shoulder, and Japanese Orthopaedic Association (JOA) score assessment were used to investigate clinical factors, analyzed by multiple regression analysis, associated with improved outcome. The average disease activity score 28 using C-reactive protein and JOA score improved significantly from 4.29 and 36.7 to 3.11 and 84.6, respectively, with the restoration of range of motion. Multiple regression analysis showed that disease duration and prednisolone were significantly associated with flexion degree and JOA score. Larsen grade and JOA score were not correlated significantly. There was no significant difference in the JOA score between the groups with or without biological medicinal treatment. Shoulder arthroscopic synovectomy performed with capsular release with or without biological treatment effectively improved function. Short disease duration and low prednisolone dose in rheumatoid arthritis were important for prediction of efficacy.
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Update on the surgical treatment for rheumatoid arthritis of the wrist and hand. J Hand Ther 2014; 27:134-41; quiz 142. [PMID: 24530143 DOI: 10.1016/j.jht.2013.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/29/2013] [Accepted: 12/01/2013] [Indexed: 02/03/2023]
Abstract
Surgical procedures for the treatment of rheumatoid arthritis are aimed at restoring function and decreasing pain. Over the past four decades multiple procedures have been described in the management of early and late disease. This article will review the most common forms of surgery used in the treatment of rheumatoid arthritis.
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