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Banks L, White D, Khodaee M. Extra-articular synovial osteochondromatosis of the knee in a recreational runner. BMJ Case Rep 2023; 16:e257627. [PMID: 38056923 PMCID: PMC10711919 DOI: 10.1136/bcr-2023-257627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- Landan Banks
- Family Medicine, University of Colorado, Denver, Colorado, USA
- Family Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Daniel White
- Family Medicine, University of Colorado, Denver, Colorado, USA
- Family Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Morteza Khodaee
- Family Medicine and Orthopedics, University of Colorado, Denver, Colorado, USA
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Chaudhary A, Dahal A, Shrestha R, Khadka SK, Maharjan S, Basi A, Acharya SP. Arthroscopic management of recurrent synovial chondromatosis of the hip: a case report. Ann Med Surg (Lond) 2023; 85:4071-4074. [PMID: 37554870 PMCID: PMC10406063 DOI: 10.1097/ms9.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Synovial chondromatosis is a rare condition characterized by the chondral proliferation of synovium forming loose bodies which can lead to pain, swelling, and decreased range of movement of the affected joint. CASE PRESENTATION 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. CLINICAL DISCUSSION 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. CONCLUSION Thus, the authors recommend arthroscopic removal of the loose bodies and partial synovectomy for the management of synovial chondromatosis of the hip.
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Affiliation(s)
| | | | - Rohit Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | | | - Sagar Maharjan
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Ashkal Basi
- Kathmandu University School of Medical Sciences
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Braun S, Flevas DA, Sokrab R, Ricotti RG, Rojas Marcos C, Pearle AD, Sculco PK. De Novo Synovial Chondromatosis following Primary Total Knee Arthroplasty: A Case Report. Life (Basel) 2023; 13:1366. [PMID: 37374148 DOI: 10.3390/life13061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
In this case report, we present a rare case of a female patient who developed pain and swelling after a total knee arthroplasty. An extensive diagnostic workup including serum and synovial testing to rule out infection was performed in addition to advanced imaging including an MRI of the knee, but it was only after an arthroscopic synovectomy that the diagnosis of secondary synovial chondromatosis was confirmed. The purpose of this case report is to highlight the occurrence of secondary synovial chondromatosis as a rare cause of pain and swelling after total knee arthroplasty, thereby assisting clinicians in providing prompt diagnosis, surgical treatment, and efficient recovery in the setting of secondary synovial chondromatosis after total knee arthroplasty.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60323 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Dimitrios A Flevas
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Ruba Sokrab
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Robert G Ricotti
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Carolena Rojas Marcos
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, New York, NY 10021, USA
| | - Peter K Sculco
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
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Chaliyadan S, Gujar A, Vallikkad S, Kataria R. Synovial Chondromatosis in a Rural Healthcare Setting. Cureus 2023; 15:e34498. [PMID: 36874332 PMCID: PMC9983506 DOI: 10.7759/cureus.34498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Synovial chondromatosis is a rare, benign, and metaplastic cause of joint swelling resulting in the formation of cartilaginous nodules in the joint space. It is usually an oligoarticular disorder of large joints that typically manifests in the third to fifth decade of life. Synovial chondromatosis can be primary or secondary depending on whether an underlying etiology can be identified. Diagnosis can be made using imaging studies of the affected joint and confirmed on histopathology. Management of synovial chondromatosis can be done arthroscopically or surgically. We present a case of a 23-year-old male who presented with a long history of right knee pain, swelling, and limitation in range of motion. An X-ray of the knee showed multiple intra-articular and soft tissue calcifications. Due to the limitations of our setting, we proceeded with an open biopsy. During arthrotomy, clear straw-colored fluid with multiple nodules of varied sizes was found. A google image search helped put us in the direction of the diagnosis of synovial chondromatosis. We did a complete evacuation of loose bodies and a biopsy of synovium, which confirmed the diagnosis. The rarity of synovial chondromatosis results in a delay in the diagnosis. With the thoughtful application of resources and surgical principles, synovial chondromatosis can be safely and effectively managed in resource-limited settings.
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Liu B, Kim SH, Jang YH, Rhee SM, Yoo JC, Kim SC, Rhee YG, Oh JH. Synovial Osteochondromatosis: Clinical Characteristics Unique to the Shoulder. Clin Orthop Surg 2023; 15:118-126. [PMID: 36779001 PMCID: PMC9880507 DOI: 10.4055/cios22078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/15/2022] [Accepted: 05/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Synovial osteochondromatosis (SOC) of the shoulder is a rare condition with unclear characteristics. This study evaluated the clinical features and postoperative functional outcomes of SOC of the shoulder that are distinct from SOC of other joints. Methods The characteristics of 28 shoulders with SOC that underwent arthroscopy were retrospectively assessed. Ten shoulders (35.7%) had rotator cuff tears (RCTs) and underwent concomitant arthroscopic rotator cuff repair. The mean follow-up period was 83.6 months (range, 24-154 months). Demographic characteristics and loose bodies localized under arthroscopy were compared between cases with and without concomitant RCTs. Radiography, ultrasonography, or magnetic resonance imaging were performed preoperatively and postoperatively. Visual analog scale (VAS) scores for pain and satisfaction were evaluated for all cases, and functional scores were assessed in shoulders with concomitant RCTs. Results The average age was 36.2 ± 15.6 years among patients without RCTs and 58.3 ± 7.2 years among patients with RCTs. Seven shoulders (7%) had osteoarthritis. Arthroscopy revealed loose bodies in multiple spaces, including the glenohumeral joint, subacromial (SA) space, and biceps tendon sheath. Overall, loose bodies were found in multiple spaces in 12 shoulders (42.9%). Loose bodies were found in the SA space only in 4 shoulders (22.2%) without RCTs and in 7 shoulders (70.0%) with RCTs. VAS for pain decreased significantly from 3.9 ± 2.3 to 1.1 ± 1.3 (p < 0.001). The functional scores increased significantly after arthroscopic management for patients with concurrent RCTs (all p < 0.05). Recurrence of SOC occurred in 3 of the 22 shoulders (13.6%) who underwent postoperative imaging, but no patient had a recurrent RCT. Conclusions Pain relief and patient satisfaction were achieved via arthroscopic management. Unlike in other joints, loose bodies can occur simultaneously in several spaces in the shoulder, including the glenohumeral joint, SA space, and biceps tendon sheath. Early diagnosis of SOC of the SA space can help prevent osteoarthritis and RCT progression.
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Affiliation(s)
- Bei Liu
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Jang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Min Rhee
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Cheol Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Bhagat SS, Hammond J, Fuller-Sincock DM, Zehra SB. Incidental Finding of Synovial Osteochondromatosis: A Case Report. Cureus 2022; 14:e28051. [PMID: 36120269 PMCID: PMC9476375 DOI: 10.7759/cureus.28051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
Synovial osteochondromatosis (SOC) is a rare, benign condition of unknown etiology characterized by the formation of cartilaginous loose bodies. This often leads to early osteoarthritis with decreased range of motion and pain. Clinical presentation most often is reported as monoarticular pain affecting the knee or less commonly the hip shoulder or elbow. Diagnosis can be confirmed on x-ray imaging where the characteristic synovial bodies will be identified. Management with early debridement of the synovium will often be curative but more complex cases may require further surgical management. We present a 33-year-old male presented with localized left knee pain. Given the history of new-onset pain, left knee x-rays were obtained that revealed a displaced patella with multiple ossific densities around the left knee which were suspicious for a new diagnosis of SOC. Due to its nonspecific symptoms and imaging, the diagnosis of SOC is often delayed or missed. Therefore, prompt diagnosis and treatment are important in order to avoid irreversible cartilage destruction in the joint, prevent the development of chronic pain, and reduce the risk of malignant transformation.
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7
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Auran RL, Martin JR, Duran MD, de Comas AM, Jacofsky DJ. Evaluation and Management of Intra-Articular Tumors of the Knee. J Knee Surg 2022; 35:597-606. [PMID: 35189664 DOI: 10.1055/s-0042-1743223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intra-articular tumors of the knee are most commonly benign. Overall, this is a relatively rare clinical presentation. The differential diagnosis includes pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, synovial hemangioma, and very rarely primary sarcoma (synovial sarcoma being the most common). The clinical presentation for these conditions is usually non-specific, but radiographic and advanced imaging findings are able to differentiate some of these tumors. It is essential to obtain and send tissue specimens to pathology for histologic analysis to rule out a primary malignancy as a missed diagnosis can have grave implications on patient outcomes. This review summarized key aspects of diagnosis and treatment for these conditions.
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Affiliation(s)
- Richard L Auran
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - John R Martin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Michael D Duran
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - Amalia M de Comas
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - David J Jacofsky
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
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Bai Z, Zhou H, Zhang C, Chen C. Arthroscopic Treatment of Atypical Synovial Osteochondromatosis of Infrapatellar Fat Pad: A 4-Year Follow-up Case Report and Literature Review. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2022; 7:60-63. [DOI: 10.14218/erhm.2021.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lee HJ, Han W, Kim K. Secondary synovial chondromatosis of the subacromial subdeltoid bursa with coexisting glenohumeral osteoarthritis: Case report. Medicine (Baltimore) 2021; 100:e27796. [PMID: 34964744 PMCID: PMC8615424 DOI: 10.1097/md.0000000000027796] [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: 09/22/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Synovial chondromatosis of the shoulder joint is uncommon; this condition usually affects the knee joint and the hip joint. Lesions of multiple chondral nodules form in the synovium and are usually found within the joint capsule. Treatment of synovial chondromatosis consists of loose body removal and synovectomy. In synovial chondromatosis of the shoulder, arthroscopic loose body removal and synovectomy have been reported with good outcomes. Arthroplasty can be a treatment option when osteoarthritis co-occurs at the affected joint. Since incidence of glenohumeral joint osteoarthritis is low compared to osteoarthritis of the knee or hip joints, reports of shoulder synovial chondromatosis treated with arthroplasty are scarce. PATIENT CONCERNS A 79-year-old woman presented with right shoulder pain with loss of motion for several years without a history of trauma. DIAGNOSES Degenerative changes in the humeral head and glenoid were noted and multiple loose bodies were found in the subdeltoid bursa, and the subacromial bursa. The pathology of loose bodies showed degenerated cartilage tissue and some bony components. Characteristic concentric rings of calcification were observed, indicative of secondary synovial chondromatosis. The diagnosis was secondary synovial chondromatosis of the subacromial subdeltoid bursa with coexisting glenohumeral osteoarthritis. INTERVENTIONS The patient was treated with loose body removal, extensive synovectomy, bursectomy and reverse total shoulder arthroplasty. OUTCOMES Visual analog scale for shoulder pain, range of motion of shoulder joint had improved demonstrating a good short-term outcome and there was no radiographic evidence of disease recurrence. LESSONS In synovial chondromatosis of the shoulder, loose bodies may form in the bursa. In combination with degenerative osteoarthritis of the glenohumeral joint, arthroplasty is a viable option.
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Affiliation(s)
- Hyun June Lee
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Weoncheol Han
- Department of Pathology, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Kyungil Kim
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
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Systematic Arthroscopic Treatment of Synovial Chondromatosis of the Knee. Arthrosc Tech 2021; 10:e2265-e2270. [PMID: 34754733 PMCID: PMC8556586 DOI: 10.1016/j.eats.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
Synovial chondromatosis is a benign metaplastic disease of the synovial joints, characterized by the development of cartilaginous nodules in the synovium. Treatment generally includes open or arthroscopic loose body removal combined with a synovectomy. An all-arthroscopic approach has been described to minimize complications and reduce morbidity while providing adequate control of local disease. The purpose of this Technical Note is to describe our techniques and technical pearls that allow for adequate excision of disease while minimizing complications and disease recurrence. The combination of patient positioning, the establishment of multiple arthroscopic portals to ensure optimal visualization and freedom of instruments, the use of a leg holder, and the use of a variety of surgical instruments to facilitate loose body removal and synovectomy is critical to optimize clinical outcomes and minimize complications. Although technically demanding, our described technique can help facilitate extensive loose body removal and complete synovectomy.
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Liu Y, Li J, Ma N, An M, Gao F, Hu B, Zhang B, Wang Z, Liu Y, Li C. Arthroscopic treatment of synovial chondromatosis of hip joint. J Orthop Surg Res 2020; 15:405. [PMID: 32917234 PMCID: PMC7488458 DOI: 10.1186/s13018-020-01928-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This retrospective study summarized the clinical, radiographic, and arthroscopic manifestation of synovial chondromatosis (SC) of the hip, along with the post-operative effect to discuss the curative effect of arthroscopic management of hip SC. METHODS Twenty-one patients who underwent arthroscopic surgery from the same surgeon for hip SC were followed up for an average of 45 months. T-shaped capsulotomy was routinely performed in each case. Visual analog scale, range of motion, modified Harris Hip Score, and International Hip Outcome Tool score were collected preoperatively and at the time of the latest follow-up. All patients' demographics, radiographs, and arthroscopic images were collected to summarize and conclude the similarities and differences of their manifestation. RESULTS Large wedged clumps of loose bodies demonstrated distinguishable radiographic, arthroscopic appearance and demanded a different surgical strategy. Postoperative scores were all significantly improved. One case of residual pain and two cases of residual loose bodies with no symptom related were reported at the final follow-up. All but one patient were satisfied with the outcome. CONCLUSION Arthroscopy treatment of hip SC with T-shaped capsulotomy has demonstrated a good result in terms of clinical outcome score, recurrence rate, and complication rate. On the basis of this study, we concluded the clinical performance of large wedged clumps of loose bodies of hip SC.
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Affiliation(s)
- Yufeng Liu
- Department of Sports Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ji Li
- Department of Sports Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ning Ma
- Institute of Orthopedic, Chinese PLA General Hospital, Beijing, 100853, China
| | - Mingyang An
- Department of Sports Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Feng Gao
- Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, 100061, China
| | - Bo Hu
- The Second Department of Orthopedics, Beijing Chaoyang Integrative Medicine Emergency Medical Center, Beijing, 100023, China
| | - Boqing Zhang
- Department of Sports Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhigang Wang
- Department of Sports Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yujie Liu
- Department of Sports Medicine, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Chunbao Li
- Department of Sports Medicine, Chinese PLA General Hospital, Beijing, 100853, China.
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Tibbo ME, Wyles CC, Rose PS, Sim FH, Houdek MT, Taunton MJ. Long-Term Outcome of Hip Arthroplasty in the Setting of Synovial Chondromatosis. J Arthroplasty 2018; 33:2173-2176. [PMID: 29550167 DOI: 10.1016/j.arth.2018.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/01/2018] [Accepted: 02/06/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Synovial chondromatosis (SC) is a rare disease involving cartilaginous metaplasia of synovial tissue. Treatment via synovectomy and loose body removal alone results in elevated recurrence rates, with up to 1 in 5 patients requiring conversion to a hip arthroplasty. The purpose of this study is to investigate outcomes of hip arthroplasty in the setting of SC, focusing on (1) disease-specific survival, (2) implant survivorship and complications, and (3) clinical outcomes. METHODS We identified 26 patients with histologically confirmed SC who underwent hip arthroplasty between 1970 and 2015. Mean follow-up and patient age were 10 years (range 2-35) and 55 years (range 26-82), respectively. At the time of arthroplasty, 21 (81%) patients had "active" disease and underwent synovectomy. No constrained acetabular components were used. Six patients (23%) had a preoperative flexion contracture. RESULTS The 15-year disease-free survival was 89%. Recurrence occurred in 3 patients at a mean of 0.8 years (range 0.03-1.2) postoperatively. Thirteen patients (50%) sustained a complication [most commonly aseptic loosening (n = 3, 12%)] and 7 required revision surgery. The 10-year and 15-year revision-free survival was 82% and 64%, respectively. Mean Harris Hip Score improved significantly from 50 (range 23-85) preoperatively to 82 (range 44-100) postoperatively (P < .001). CONCLUSION Arthroplasty with simultaneous synovectomy provides reliable pain relief and excellent disease-specific survival at long-term follow-up; however, revision and complication rates were high.
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Affiliation(s)
- Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Franklin H Sim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Houdek MT, Wyles CC, Rose PS, Stuart MJ, Sim FH, Taunton MJ. High Rate of Local Recurrence and Complications Following Total Knee Arthroplasty in the Setting of Synovial Chondromatosis. J Arthroplasty 2017; 32:2147-2150. [PMID: 28364965 DOI: 10.1016/j.arth.2017.02.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/06/2017] [Accepted: 02/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Synovial chondromatosis is a rare, monoarticular arthropathy due to synovial metaplasia. There is a paucity of data examining the outcome of total knee arthroplasty (TKA) in the setting of synovial chondromatosis. The purpose of this study is to investigate the outcome and function in patients undergoing TKA for management of synovial chondromatosis. METHODS Twenty patients who received TKA for synovial chondromatosis over a 25-year period were identified for analysis and followed for a mean of 7 years. There were 12 males and 8 females, with a mean age and body mass index of 63 years and 30.7 kg/m2. Seventeen patients had "active" disease at the time of surgery. RESULTS The 5-year disease-free survival was 73%. Five patients sustained a recurrence that was treated with synovectomy and revision TKA (n = 2), observation (n = 2), and transfemoral amputation (n = 1) due to malignant degeneration to chondrosarcoma. One of the revision TKA patients underwent a transfemoral amputation 4 months later for recurrence. The overall rate of amputation was 10%. Nine patients (45%) sustained a complication, most commonly decreased knee motion (n = 7), leading to a revision TKA in 3 patients (15%). Mean preoperative knee range of motion was 73°, which improved to 97° postoperatively. The Knee Society Score and functional assessment improved from 35 and 42 preoperatively to 74 and 67 following TKA. CONCLUSION TKA in the setting of synovial chondromatosis improves patient function and knee range of motion; however, there is a high rate of local recurrence and complications.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Franklin H Sim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Shah A, James SL, Davies AM, Botchu R. A diagnostic approach to popliteal fossa masses. Clin Radiol 2016; 72:323-337. [PMID: 28007292 DOI: 10.1016/j.crad.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/10/2016] [Accepted: 11/21/2016] [Indexed: 02/07/2023]
Abstract
There is a myriad of potential mass lesions that occur in the popliteal fossa, which present as palpable masses or are found incidentally on imaging. With a thorough knowledge and understanding of the appearances and locations of these different entities, one can narrow the differential diagnoses in the majority of cases. This will eliminate unnecessary additional investigations and enable a more rapid management. We present a review of frequently encountered and less common entities using an anatomical sieve, with the aim of providing a diagnostic approach to popliteal fossa masses.
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Affiliation(s)
- A Shah
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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15
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Wilson J, Riff AJ, Hellman MD, Sethi S, Jacobs JJ, Gitelis S. A Novel Complication of the Dall-Miles Cable Grip System Mimicking Recurrent Synovial Chondromatosis: A Case Report and Review of the Literature. JBJS Case Connect 2016; 6:e87. [PMID: 29252741 DOI: 10.2106/jbjs.cc.16.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 25-year-old man with synovial chondromatosis of the hip was treated with a synovectomy through a transtrochanteric approach; the repair was made with use of a Dall-Miles cable. Approximately 13 years later, the patient returned with a massive bursal reaction and a cyst containing "rice bodies." Although the physical examination and imaging were suggestive of recurrent synovial chondromatosis, the bursal reaction actually represented a novel complication of the Dall-Miles system. CONCLUSION When a patient who has had prior orthopaedic instrumentation presents with pain and imaging that demonstrates formation of a bursal cyst, a cyst containing rice bodies secondary to bursal irritation by the implant should be considered.
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Affiliation(s)
- Jacob Wilson
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew J Riff
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
| | - Michael D Hellman
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
| | - Shenon Sethi
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
| | - Joshua J Jacobs
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
| | - Steven Gitelis
- Departments of Orthopaedic Surgery (A.J.R., M.D.H., J.J.J., and S.G.) and Pathology (S.S.), Rush University Medical Center, Chicago, Illinois
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Deinum J, Nolte PA. Total Knee Arthroplasty in Severe Synovial Osteochondromatosis in an Osteoarthritic Knee. Clin Orthop Surg 2016; 8:218-22. [PMID: 27247750 PMCID: PMC4870328 DOI: 10.4055/cios.2016.8.2.218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 02/04/2016] [Indexed: 11/07/2022] Open
Abstract
Synovial osteochondromatosis (SO) can occur idiopathic or secondary to osteoarthritis. SO can be easily diagnosed with plain film radiography and clinical findings. In case of disabling osteoarthritis, total knee arthroplasty and removal of all corpora libra are indicated. We present a 71-year-old woman with significant osteoarthritis and severe SO intra-articular and in the suprapatellar bursa of the right knee. Total knee arthroplasty, extraction of the loose bodies, and partial synovectomy were performed. During a 2.5-year follow-up, the patient regained full function of her affected knee and there was no recurrence of SO. We choose to present this case to show the extensiveness SO can occur in. Our advice is to remove all the loose bodies carefully to prevent damage to the prosthesis. During follow-up, special attention should be paid to prevent recurrence of SO. When recurrence is associated with rapid growth or destruction of joints, malignant reoccurrence must be considered.
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Affiliation(s)
- Joukje Deinum
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands
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Multiple stones in the knee. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2015.11.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Dastgheyb SS, Hammoud S, Ketonis C, Liu AY, Fitzgerald K, Parvizi J, Purtill J, Ciccotti M, Shapiro IM, Otto M, Hickok NJ. Staphylococcal persistence due to biofilm formation in synovial fluid containing prophylactic cefazolin. Antimicrob Agents Chemother 2015; 59:2122-8. [PMID: 25624333 PMCID: PMC4356782 DOI: 10.1128/aac.04579-14] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/21/2015] [Indexed: 11/20/2022] Open
Abstract
Antibiotic prophylaxis is standard for patients undergoing surgical procedures, yet despite the wide use of antibiotics, breakthrough infections still occur. In the setting of total joint arthroplasty, such infections can be devastating. Recent findings have shown that synovial fluid causes marked staphylococcal aggregation, which can confer antibiotic insensitivity. We therefore asked in this study whether clinical samples of synovial fluid that contain preoperative prophylactic antibiotics can successfully eradicate a bacterial challenge by pertinent bacterial species. This study demonstrates that preoperative prophylaxis with cefazolin results in high antibiotic levels. Furthermore, we show that even with antibiotic concentrations that far exceed the expected bactericidal levels, Staphylococcus aureus bacteria added to the synovial fluid samples are not eradicated and are able to colonize model implant surfaces, i.e., titanium pins. Based on these studies, we suggest that current prophylactic antibiotic choices, despite high penetration into the synovial fluid, may need to be reexamined.
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Affiliation(s)
- Sana S Dastgheyb
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, Maryland, USA
| | | | - Constantinos Ketonis
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA The Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Andrew Yongkun Liu
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Keith Fitzgerald
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Javad Parvizi
- The Rothman Institute, Philadelphia, Pennsylvania, USA
| | - James Purtill
- The Rothman Institute, Philadelphia, Pennsylvania, USA
| | | | - Irving M Shapiro
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Otto
- National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, Maryland, USA
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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19
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Bassir RA, Ismael F, Elbardouni A, Mahfoud M, Berrada MS, Elyaacoubi M. Bilateral synovial chondromatosis in the knee joint with both intra and extra-articular diseases. Pan Afr Med J 2015; 19:57. [PMID: 25667719 PMCID: PMC4317074 DOI: 10.11604/pamj.2014.19.57.4054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/04/2014] [Indexed: 12/02/2022] Open
Abstract
Synovial chondromatosis is a rare disease of unknown etiology. It usually occurs unilaterally in the large joints like the knee, but may occur in the shoulder, elbow, hip, ankle and temporomandibular joints. The disease is usually intracapsular, but can also be extracapsular on rare occasions. The diagnosis of synovial chondromatosis is given after an anamnesis, physical examination and radiographic examination. However, the diagnosis is obtained after histological examination of the synovial tissue. We report an unusual presentation of bilateral synovial chondromatosis in the knee joint, with both intra and extracapsular localization. never described in the literature. Although synovial chondromatosis is described as a benign disease, it can be very destructive and debilitating. These lesions can mimic a malignant tumor and present a diagnostic problem.
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Affiliation(s)
- Rida-Allah Bassir
- Department of Orthopaedic Surgery and Traumatology, Mohamed V, Souissi University, Rabat, Morocco
| | - Farid Ismael
- Department of Orthopaedic Surgery and Traumatology, Mohamed V, Souissi University, Rabat, Morocco
| | - Ahmed Elbardouni
- Department of Orthopaedic Surgery and Traumatology, Mohamed V, Souissi University, Rabat, Morocco
| | - Mustapha Mahfoud
- Department of Orthopaedic Surgery and Traumatology, Mohamed V, Souissi University, Rabat, Morocco
| | - Mohamed Saleh Berrada
- Department of Orthopaedic Surgery and Traumatology, Mohamed V, Souissi University, Rabat, Morocco
| | - Moradh Elyaacoubi
- Department of Orthopaedic Surgery and Traumatology, Mohamed V, Souissi University, Rabat, Morocco
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20
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Arthroscopic surgery for synovial chondromatosis of the hip: a systematic review of rates and predisposing factors for recurrence. Arthroscopy 2014; 30:1499-1504.e2. [PMID: 25064754 DOI: 10.1016/j.arthro.2014.05.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Synovial chondromatosis of the hip is a benign condition whereby pain and functional limitations occur due to numerous intra-articular osteochondral fragments produced by a metaplastic synovium. Recurrence not only worsens morbidity but may lead to malignant transformation. With reported recurrence rates as high as 22% by open surgical approaches and given the increasing use of hip arthroscopy for the treatment of synovial chondromatosis, we sought to quantify the recurrence rate after arthroscopy, as well as identify predisposing factors for recurrence. METHODS Using predetermined inclusion criteria, 3 electronic databases--Embase, Medline, and PubMed-were searched for relevant articles addressing arthroscopic surgery for synovial chondromatosis of the hip across all available dates up to and including February 16, 2014. A hand search of the reference sections of the included studies was also completed. Article screening was conducted in duplicate. Reviewer agreement statistics and descriptive statistics of the included studies are presented. RESULTS From an initial retrieval of 2,542 studies, 14 studies satisfied the criteria for inclusion. A total of 197 patients (age range, 13 to 81 years) underwent hip arthroscopy for removal of intra-articular osteochondral fragments and synovectomy to alleviate both mechanical symptoms and pain. Follow-up periods ranged from 1 to 184 months, with approximately 7.6% of patients (15 of 197) lost to follow-up. The recurrence rate after hip arthroscopy was 7.1% (14 of 197), and the rate of minor complications, such as perineal and pedal neurapraxia, was 1%. CONCLUSIONS For synovial chondromatosis of the hip, arthroscopic removal of osteochondral fragments with synovectomy is both safe and effective, with a mean recurrence rate of 7.1%. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Abstract
Primary bone and soft-tissue tumors that mimic common sports injuries are relatively rare and are not often encountered by most orthopaedists. Prompt and accurate diagnosis of these tumors is crucial to maximize the clinical outcome. Many bone and soft-tissue tumors present disproportionately in young and active patients who are often involved in athletic activities. Thus, the clinician may misdiagnose these rare tumors as more common sports injuries. Symptoms that should raise suspicion for a neoplastic process include pain unrelated to activity and a clinical course that does not follow the typically expected recovery for a common sports injury. An awareness of the salient features of several bone and soft-tissue tumors as well as nononcologic processes that may simulate sports injuries can aid clinicians in the prompt diagnosis and clinical decision making of these rare tumors.
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Crawford MD, Kim HT. New-onset synovial chondromatosis after total knee arthroplasty. J Arthroplasty 2013; 28:375.e1-4. [PMID: 22704224 DOI: 10.1016/j.arth.2012.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/13/2012] [Indexed: 02/01/2023] Open
Abstract
Total joint arthroplasty is commonly recommended as a definitive treatment for synovial chondromatosis refractory to other treatment. We describe a unique case of synovial chondromatosis developing after total joint arthroplasty in a patient presenting 5 years after total knee arthroplasty for osteoarthritis. This case illustrates that the diagnosis of synovial chondromatosis cannot be excluded in a patient with chronic, painful swelling of a joint, even after total joint arthroplasty.
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Affiliation(s)
- Matthew D Crawford
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
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Abstract
Pseudopseudohypoparathyroidism (PPH) is a rare genetic disorder characterized by multiple musculoskeletal anomalies and normal serum calcium, phosphate, and parathyroid hormone levels. Although the musculoskeletal manifestations of PPH are well known, little has been reported on the management of orthopedic problems. We report a case of total knee arthroplasty (TKA) performed in a patient with PPH. To our knowledge, this case is not only unique to the arthroplasty literature but is the first report of its kind. This report illustrates the unique pathoanatomy of PPH, the medical and surgical management required, and a previously unreported musculoskeletal abnormality associated with PPH: synovial osteochondromatosis of the knee. Common musculoskeletal anomalies associated with PPH include shortening/bowing of long bones; shortening of metacarpals, metatarsals, and/or phalanges; exostoses; calcification/ossification of subcutaneous and/or periarticular soft tissues; a thickened calvarium; microcephaly; bony coalitions of the hand; vertebral column abnormalities; cubitus valgus; radius/ulna curvus; coxa vara; coxa valga; and genu valgum. This case is the first to report an association of synovial osteochondromatosis with PPH. Because synovial osteochondromatosis and PPH share a common disorder of soft tissue calcification/ossification, as well as abnormal bone formation, this clinical finding does not seem merely coincidental.
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Mackenzie H, Gulati V, Tross S. A rare case of a swollen knee due to disseminated synovial chondromatosis: a case report. J Med Case Rep 2010; 4:113. [PMID: 20416049 PMCID: PMC2873448 DOI: 10.1186/1752-1947-4-113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 04/23/2010] [Indexed: 11/30/2022] Open
Abstract
Introduction A synovial chondromatosis is a rare benign neoplasm on the synovium. Although described as a benign disease, it can be very destructive and can cause severe osteoarthritis and pain. To the best of our knowledge, we report the first known case of an extensive presentation of this intra-articular and extra-articular disease of the knee joint. Case presentation A 49-year-old Caucasian man presented with right knee pain and stiffness caused by diffuse intra-articular and extra-articular synovial chondromatosis. He underwent careful preoperative imaging and planning followed by a two-stage arthroscopic and open procedure in order to completely eradicate the disease. He has regained full range of movement, but continues to experience residual pain due to severe osteoarthritis. Conclusions Although synovial chondromatosis is described as a benign disease, it can be very destructive and debilitating. A challenging management dilemma arises when confronted with both synovial chondromatosis and osteoarthritis.
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Affiliation(s)
- Hugh Mackenzie
- Department of Orthopaedics, Ealing Hospital, Uxbridge Road, Southall, Middlesex UB1 3HW, UK.
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Abstract
Synovial chondromatosis is a rare condition of metaplastic cartilage development in the synovial membrane of joints. These foci can form free bodies and lead to mechanical arthrosis. The precise etiology is unknown. All synovial joints can be affected, with the hip and knee being most common. Patients with synovial chondromatosis are usually in their fifth decade and typically present with mechanical pain and diffuse swelling. Due to its rarity and nonspecific manifestations, diagnosis of synovial chondromatosis is often delayed until significant mechanical damage and arthrosis has occurred.Controversy exists regarding surgical treatment of synovial chondromatosis, especially with regard to the hip. Localized disease can be treated with resection of affected synovium (possibly arthroscopically), whereas patients with generalized disease require complete, open synovectomy. With articular damage, total hip replacement has been advocated along with synovectomy.This article presents a case of a young man with painful hip synovial chondromatosis who was successfully treated with hip resurfacing and synovectomy after failed hip arthroscopy. Hip resurfacing provides the surgeon with the opportunity to address not only local or generalized synovial disease, but articular damage as well. Furthermore, its bone-preserving properties make this option attractive in the management of this younger patient population. We feel resurfacing has a role in the surgical treatment of synovial chondromatosis. To our knowledge, this is the first case of hip resurfacing arthroplasty for the definitive treatment of synovial chondromatosis.
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Affiliation(s)
- April Ligato
- Department of Orthopedic Surgery, UCLA, 10945 Le Conte Ave, Ste 33-55, PVUB, Los Angeles, CA 90095, USA
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26
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Abstract
Primary articular synovial chondromatosis is a benign, self-limiting neoplastic process in which hyaline cartilage nodules form in the synovial tissue. The disease most frequently affects the knee in men, followed by the elbow. The basic feature of this disease is a metaplastic maturation of the mesenchymal cells in the synovial membrane of a joint into cartilage. These cells mature into chondroblasts and form small nodules of cartilage in the synovial membrane. These nodules subsequently enlarge and detach to lie within the joint space. They become free within the joint as multiple small cartilaginous loose bodies nourished by the synovial fluid. The chondrocytes in the loose bodies continue to multiply, and the loose bodies grow in diameter. Calcification appears in the central zone of the loose bodies, and in some cases, enchondral ossification takes place. The operative therapy depends on the stage of the disease: synovectomy with removal of chondral fragments if active intrasynovial disease is present, and removal of the multiple chondral bodies alone in cases of late inactive disease with no synovial abnormalities. Malignant transformation is unusual and can be difficult to distinguish from benign disease.
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Affiliation(s)
- M Fuerst
- Lehrstuhl für Orthopädie, Klinikum Bad Bramstedt, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Deutschland.
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