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Zeng W, Yu Z, Wang S, Chen A, Zeng Y, Yang Q, Li Y, Li Q, Zhou Z. Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial. Chin Med J (Engl) 2023; 136:73-81. [PMID: 36780427 PMCID: PMC10106132 DOI: 10.1097/cm9.0000000000002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up. METHODS This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery. RESULTS At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t = 0.221, P = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U = 789.500, P = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively ( P > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups ( P > 0.05). CONCLUSIONS Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj=13334 .
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Affiliation(s)
- Weinan Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zeping Yu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Simeng Wang
- Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China
| | - Anjing Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yiping Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qingjun Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yujuan Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qi Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Sundaram K, Arnold NR, Mont MA, Sodhi N, Warren J, Kamath AF, Piuzzi NS. Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis. J Knee Surg 2021; 34:877-885. [PMID: 31891962 DOI: 10.1055/s-0039-3402482] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding this therapy. This meta-analysis aims to assess the rate of symptom relief, the number of embolizations needed to achieve relief, and the rate of complications associated with embolization. Public databases were queried from 1998 until 2018 for TKA-associated recurrent hemarthroses treated with embolization. Eight studies met inclusion and exclusion criteria. Major complications were defined as those requiring readmission or nonelective reoperation; minor complications were defined as those not requiring readmission or reoperation. Pooled statistics were calculated utilizing the method of inverse variance. Fifty-nine patients with a mean follow-up of 30 months (range, 1-50 months) were evaluated. The pooled proportion of patients with symptom improvement following embolization was 86% (95% confidence interval [CI]: 74-93%, I 2: 0%, p = 0.97). The average number of embolization procedures was 1.30 (95% CI: 1.03-1.63, I 2: 0%, p = 0.66). The pooled proportion of patients who required a second embolization procedure was 26% (95% CI: 15-40%, I 2: 0%, p = 0.43), while those requiring three or more procedures was 13% (95% CI: 6-25%, I 2: 0%, p = 0.87). The rate of complications were as follows: any complication - 19% (95% CI: 11-32%, I 2: 0%, p = 0.81); major complications-8% (95% CI: 3-19%, I 2: 0%, p = 0.96); minor complications-18% (95% CI: 10-31%, I 2: 0%, p = 0.79); inguinal hematoma-9% (95% CI: 4-19%, I 2: 0%, p = 1.00); skin necrosis-15% (95% CI: 7-29%, I 2: 0%, p = 0.62); and incision breakdown-7% (95% CI: 3-17%, I 2: 0%, p = 1.00). Previous literature on selective artery embolization following TKA is relatively limited. This meta-analysis supports embolization as a potentially safe and effective treatment for recurrent hemarthroses after TKA. Other correctable causes of recurrent hemarthrosis, such as instability or malalignment, must be diligently ruled out prior to utilizing embolization. Surgeons should be aware of embolization's potential role in the postoperative period following TKA.
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Affiliation(s)
- Kavin Sundaram
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicholas R Arnold
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Jared Warren
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Liu P, Lu F, Chen J, Xia Z, Yu H, Zhang Q, Wang W, Guo W. Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials. J Orthop Surg Res 2019; 14:283. [PMID: 31464637 PMCID: PMC6716854 DOI: 10.1186/s13018-019-1332-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022] Open
Abstract
Background During primary total knee arthroplasty (TKA), synovectomy as a part of the procedure has been recommended to relieve pain and inflammation of the synovium, but there is a controversy about it due to increased bleeding. In this meta-analysis, the aim is to answer whether synovectomy should be performed routinely during TKA for symptomatic knee osteoarthritis (KOA). Methods Relevant randomized controlled trials (RCTs) on synovectomy were retrieved through database searches of PubMed, Embase, Web of Science, and Cochrane Library up to February 2019. Studies that compared postoperative pain, clinical Knee Society Score (KSS), functional KSS, range of motion (ROM), drainage, pre- and postoperative hemoglobin difference, transfusion rate, operative time, and/or complications were included in the meta-analysis. Review Manager 5.3.0 was used for meta-analysis. Results We included 5 RCTs with 542 knees. Pooled results indicated that the synovectomy group was associated with more blood loss via drainage (WMD = − 99.41, 95% CI − 153.75 to − 45.08, P = 0.0003) and pre- and postoperative hemoglobin difference (WMD = − 0.93, 95% CI − 1.33 to − 0.5, P < 0.00001), compared with the non-synovectomy group. No statistically significant differences were demonstrated between both groups in postoperative pain, clinical KSS, functional KSS, ROM, transfusion rate, or complications (P > 0.05). Conclusions The current evidence demonstrates that performing synovectomy in primary TKA for symptomatic KOA does not have any clinical benefit. It increases postsurgical blood loss. Surgeons routinely undertaking synovectomy should deliberate whether this is clinically indicated and consider limiting resection, if possible.
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Affiliation(s)
- Pei Liu
- Beijing University of Chinese Medicine, Yinghuadong Road, Chaoyang District, Beijing, China
| | - Feifan Lu
- China-Japan Friendship School of Clinical Medicine, Peking University, Yinghuadong Road, Chaoyang District, Beijing, China
| | - Jialiang Chen
- Beijing University of Chinese Medicine, Yinghuadong Road, Chaoyang District, Beijing, China
| | - Ziqi Xia
- Beijing University of Chinese Medicine, Yinghuadong Road, Chaoyang District, Beijing, China
| | - Huachen Yu
- Graduate School, Peking Union Medical College, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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Rankin KS, Ramaskandhan J, Bardgett M, Merrie K, Gangadharan R, Wilson I, Deehan D. Synovectomy during total knee arthroplasty: a pilot single-centre randomised controlled trial. Pilot Feasibility Stud 2018; 4:145. [PMID: 30151238 PMCID: PMC6109454 DOI: 10.1186/s40814-018-0336-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is an effective procedure for late-stage osteoarthritis (OA) of the knee; however, up to 20% of patients remain dissatisfied. In some patients, this may be due to residual inflammation of the synovium. Our aim was to perform the first randomised controlled trial (RCT) of synovectomy during TKA for patients with macroscopically inflamed synovium. The main objectives were to assess recruitment rates, protocol adherence and outcomes relating to safety such as haemoglobin decrease and adverse events. We also collected data on patient-reported outcomes. Methods We performed a single-centre pilot RCT. Patients with a macroscopically inflamed synovium were randomised to receive synovectomy versus a control group that did not undergo synovectomy. We determined feasibility by measuring patient enrolment, completeness of follow-up, and safety via haemoglobin decrease and documentation of adverse events. Results We screened 360 patients with 260 deemed ineligible or could not be recruited. From the 100 eligible patients, 54 were enrolled and 40 progressed through to randomisation. All made it to the 12-month follow-up, indicating good protocol adherence. There were no major differences in adverse events or haemoglobin decrease demonstrating acceptable safety. Outcomes relating to satisfaction were reliably obtained. Conclusions Patients with macroscopically inflamed synovium of the knee who are due to undergo TKA can be reliably recruited to a randomised trial and synovectomy can be performed safely. A large number is needed to be screened to identify eligible participants, and therefore, a multi-centre trial would be required to assess whether routine synovectomy would improve outcomes in these patients. Trial registration ISRCTN, ISRCTN31010214. Registered 6 October 2016—retrospectively registered Electronic supplementary material The online version of this article (10.1186/s40814-018-0336-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kenneth S Rankin
- 1Musculoskeletal Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Jayasree Ramaskandhan
- 1Musculoskeletal Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Michelle Bardgett
- 1Musculoskeletal Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Katie Merrie
- 1Musculoskeletal Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Rajkumar Gangadharan
- 1Musculoskeletal Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Ian Wilson
- 2Institute of Genetic Medicine, University of Newcastle upon Tyne, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ UK
| | - David Deehan
- 1Musculoskeletal Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
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Abstract
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.
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Influence of synovectomy on blood loss and need for transfusion in standard total knee replacement. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018. [PMID: 29523973 DOI: 10.1007/s00590-018-2160-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Synovial proliferation is a rather frequent intraoperative finding during the surgery of a total knee replacement. The aim of this study is to asses whether the standard procedure of a synovectomy results in changes in blood loss and in the need for transfusion in the immediate postoperative time after the total knee replacement. METHODS A prospective cohort study was performed with 120 patients undergoing total knee replacement (60 with synovectomy and 60 without it). Data on gender, age, and hemoglobin concentration prior to and after surgery were obtained. A bivariate and multivariate logistic regression analysis was performed. RESULTS The male gender as a protective factor [RR 0.25 (0.06-1.01)] and the low preoperative hemoglobin as a risk factor [RR 6.22 (2.48-15.58)] were significant in bivariate analysis. However, only the presence of low preoperative hemoglobin was shown to have an independent risk factor for the need for transfusion [RR 8.55 (2.77-26.45)]. CONCLUSION The practice of synovectomy showed no difference either in blood loss or in the number of transfusions. The findings of this study indicate that the practice of a synovectomy in a standard total knee replacement does not generate any benefit or prejudice as to the blood factor of the total knee arthroplasty.
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Patel N, Gwam CU, Khlopas A, Sodhi N, Sultan AA, Navarro SM, Ramkumar PN, Harwin SF, Mont MA. Outcomes of Cementless Total Knee Arthroplasty in Patients With Rheumatoid Arthritis. Orthopedics 2018; 41:103-106. [PMID: 29377055 DOI: 10.3928/01477447-20180123-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/06/2017] [Indexed: 02/03/2023]
Abstract
The objective of this study was to evaluate implant survivorship, clinical outcomes, postoperative complications, and radiographic outcomes of cementless total knee arthroplasty (TKA) in patients who have rheumatoid arthritis (RA). Patients who underwent a primary cementless posterior-stabilized TKA and who had RA were reviewed. A total of 126 TKAs in 122 patients who had a mean follow-up of 4 years were analyzed. Implant survivorship was calculated. Postoperative clinical and radiographic follow-up was performed at approximately 6 weeks and 3 months and then annually. Changes in range of motion and Knee Society scores were noted. Radiographic evaluation was conducted as part of the follow-up process. Implant survivorship was 99.2%, with 1 aseptic failure. At final follow-up, mean extension and flexion were 2° (range, 0°-10°) and 124° (range, 95°-140°), respectively. Mean Knee Society pain and function scores were 92 points (range, 80-100 points) and 84 points (range, 70-90 points), respectively. There were no surgical complications. No progressive radiolucencies, loosening, or subsidence were noted except from the single aseptic failure reported. This study reports excellent survivorship and clinical and radiographic outcomes of cementless TKAs in RA patients. Although the decision regarding whether to use cemented or cementless TKAs in these patients should be based on surgeon experience and patient characteristics, the recent advances in implant fixation of cementless TKAs indicate no salient contraindications for RA patients. [Orthopedics. 2018; 41(2):103-106.].
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Bernal-Fortich LD, Aguilar CA, Rivera-Villa AH, Galindo-Avalos J, Aguilera-Martínez P, Torres-González R, Colin-Vázquez A. A prospective randomized trial of total synovectomy versus limited synovectomy in primary total knee arthroplasty: evaluation of bleeding, postoperative pain, and quality of life with SF-12 v2. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:701-706. [PMID: 29383503 DOI: 10.1007/s00590-018-2139-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND During total knee arthroplasty (TKA), total synovectomy (TS) as a part of the surgical technique has been proposed to reduce the inflammatory tissue after the procedure, but there is a controversy about it because of the risk of major postsurgical bleeding. The aim of this study was to compare postoperative bleeding, pain, and health-related quality of life (HRQOL) after a TKA when a TS is performed and when it is not. METHODS The difference in pre and postoperative hemoglobin was measured, as well as postoperative pain using visual analogue scale (VAS) scores at 24 and 48 h post-surgical, HRQOL was measured prior to surgery and at one year using the SF-12V2 questionnaire. RESULTS We assessed a total of 148 patients (73 for TS and 75 for limited synovectomy). We have found a difference of 0.9 mg/dl of pre- and postoperative hemoglobin between both groups, with a higher bleeding amount for the TS group (P = 0.0000647); VAS scores were slightly lower for the TS group at 24 and 48 h after surgery, but not relevant. The TS group required transfusion in 13.3% and the limited synovectomy group in 6.8%. No significant differences in HRQOL were found in both groups at 1 year follow-up. CONCLUSIONS Performing a TS in TKA in patients with osteoarthrosis does not result in a relevant lower postoperative pain, or in an improvement in HRQOL, and it does increase the amount of bleeding after the procedure.
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Affiliation(s)
- Luis Dario Bernal-Fortich
- UMAE "Dr. Victorio de la Fuente Narváez" IMSS-UNAM, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico.
| | - Carlos Alberto Aguilar
- Joint Replacement Surgery Department, UMAE Traumatology, Orthopedics and Rehabilitation "Dr. Victorio de la Fuente Narváez" IMSS, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Adrián H Rivera-Villa
- Joint Replacement Surgery Department, UMAE Traumatology, Orthopedics and Rehabilitation "Dr. Victorio de la Fuente Narváez" IMSS, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Joel Galindo-Avalos
- UMAE "Dr. Victorio de la Fuente Narváez" IMSS-UNAM, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Pedro Aguilera-Martínez
- Joint Replacement Surgery Department, UMAE Traumatology, Orthopedics and Rehabilitation "Dr. Victorio de la Fuente Narváez" IMSS, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Rubén Torres-González
- Health Education and Research Department, UMAE Traumatology, Orthopedics and Rehabilitation "Dr. Victorio de la Fuente Narváez" IMSS, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Avelino Colin-Vázquez
- UMAE "Dr. Victorio de la Fuente Narváez" IMSS-UNAM, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
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Lei P, Sun R, Liu H, Zhu J, Wen T, Hu Y. Prognosis of Advanced Tenosynovial Giant Cell Tumor of the Knee Diagnosed During Total Knee Arthroplasty. J Arthroplasty 2017; 32:1850-1855. [PMID: 28161138 DOI: 10.1016/j.arth.2016.12.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tenosynovial 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. METHODS From 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). RESULTS All 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). CONCLUSION Inactive TGCT could not be diagnosed preoperatively. TKA combined with synovectomy is effective in the treatment of advanced TGCT with degenerative lesions.
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Affiliation(s)
- Pengfei Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Rongxin Sun
- Department of Orthopaedics, The Six Affiliated Hospital, Xinjiang Medical University, Urumchi, People's Republic of China
| | - Hao Liu
- Program of Biology and Biomedical Sciences, Division of Medical Sciences, Harvard Medical School, Harvard University, Cambridge, Massachusetts
| | - Jianxi Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ting Wen
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yihe Hu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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Administering aspirin, rivaroxaban and low-molecular-weight heparin to prevent deep venous thrombosis after total knee arthroplasty. Blood Coagul Fibrinolysis 2014; 25:660-4. [DOI: 10.1097/mbc.0000000000000121] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lee GC, Lotke PA. Does chondrocalcinosis affect Knee Society scores and range of motion after TKA? Clin Orthop Relat Res 2014; 472:1512-7. [PMID: 24385044 PMCID: PMC3971233 DOI: 10.1007/s11999-013-3447-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/20/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chondrocalcinosis is manifested by crystalline deposits of calcium commonly found during primary TKA for osteoarthritis. Its frequency among patients undergoing TKA is poorly defined, as is its influence on pain or function after TKA. QUESTIONS/PURPOSES The purposes of this study are to (1) determine the prevalence of chondrocalcinosis in patients undergoing TKA for osteoarthritis; (2) evaluate the effect of chondrocalcinosis on ROM and The Knee Society scores; (3) determine if patients with chondrocalcinosis and severe synovitis who underwent synovectomy are at risk for lower postoperative Knee Society scores and less ROM; and (4) assess if chondrocalcinosis is associated with increased rates of revision surgery. METHODS We retrospectively reviewed the medical records of 1500 primary TKAs performed by one surgeon. The minimum followup for patients was 24 months (average, 57 months; range, 24-120 months). There were 511 men and 934 women with an average age of 70 years. Fifty-five patients underwent bilateral knee replacements. Crystal deposition was graded prospectively during surgery using a subjective visual scale. A thorough synovectomy was performed on patients with severe synovitis and apparent crystalline deposition suggestive of calcium pyrophosphate dihydrate (CPPD) deposition (n = 50). The Knee Society scores, ROM, and revision rates were compared between patients with visible chondrocalcinosis with those without and between patients with mild chondrocalcinosis with those with severe chondrocalcinosis. RESULTS Chondrocalcinosis was found in 173 male patients (34%) undergoing TKAs during this period compared with 224 female patients (24%) (p < 0.001). The Knee Society scores for knee rating and function were similar in patients with or without chondrocalcinosis undergoing TKA. However, patients with visible CPPD deposition who underwent synovectomy for proliferative synovitis had diminished final ROM and Knee Society knee rating scores (107(o) versus 115(o) knee flexion, p < 0.001 and 87 versus 94 points, p = 0.001). We cannot determine whether this result is because of the synovectomy or severity of the disease, and therefore we cannot recommend a synovectomy at this time. Revision rates were no different among patients with chondrocalcinosis compared with those without it (3.6% versus 2.2%, p = 0.2). CONCLUSIONS Chondrocalcinosis is common among patients undergoing TKA for osteoarthritis. The presence of CPPD deposition does not appear to affect the ROM and Knee Society scores of patients with CPPD but without severe synovitis. However, patients with severe synovitis and visible CPPD who underwent thorough synovectomy may be at risk for having decreased postoperative ROM and pain develop. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopedic Surgery, University of Pennsylvania, 1 Cupp Pavilion, 39th and Market Streets, Philadelphia, PA, 19104, USA,
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Zhaoning X, Xu Y, Shaoqi T, Baiqiang H, Kang S. The effect of synovectomy on bleeding and clinical outcomes for total knee replacement. Bone Joint J 2013; 95-B:1197-200. [PMID: 23997131 DOI: 10.1302/0301-620x.95b9.31253] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A total of 187 patients with primary osteoarthritis (OA) of the knee undergoing total knee replacement (TKR) were randomly divided into two groups, one of which underwent synovectomy. The patients and assessors were blinded to the randomisation both before and after surgery. The duration of surgery, hospitalisation period, concealed bleeding, drainage volume, blood transfusion rate and range of movement of the knee at three days after the operation were analysed. Patients were followed up at four weeks and 12 months after their operation, and a visual analogue score (VAS) for pain, Knee Society score (KSS) and a patellar ballottement test were compared between the groups. The mean amount of concealed bleeding was higher in the synovectomy group compared with the control group (1.24 l (0.08 to 3.28) vs 1.03 l (0.16 to 2.94); p = 0.042), as was the mean drainage volume (0.90 l (0.35 to 1.81) vs 0.81 (0.25 to 1.65); p = 0.030). The mean operating time was also higher in the synovectomy group compared with the controls (1.50 hours (1.34 to 1.75) vs 1.41 hours (1.21 to 1.79); p = 0.006). There were no significant differences in blood transfusion rate (p = 0.882), hospital stay (p = 0.805) or range of movement of the knee (p = 0.413) between the two groups. At four weeks and 12 months post-operatively there were no statistically significant differences in any of the measured parameters. We concluded that synovectomy confers no clinical advantages in TKR for primary OA while subjecting patients to higher levels of bleeding and longer operating times.
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Affiliation(s)
- X Zhaoning
- Affiliated Hospital of Qingdao University Medical College, Department of Articular Surgery, 16 Jiangsu street, Qingdao, Shandong, China
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