High Rate of Local Recurrence and Complications Following Total Knee Arthroplasty in the Setting of Synovial Chondromatosis

[Synovial chondromatosis : Results from the histopathological arthritis register of the German Society for Orthopedic Rheumatology]

BACKGROUND

Synovial chondromatosis, or osteochondromatosis, is a rare benign disorder that occurs in joints, tendon sheaths, or bursae, characterized by cartilage proliferations of varying sizes and shapes, often with ossifications. In this study the prevalence, sensitivity, gender predominance, differential diagnoses, and primary localization of synovial chondromatosis are analyzed within the Histopathological Arthritis Registry of the German Society for Orthopedic Rheumatology.

METHODS

All cases of patients diagnosed with "synovial chondromatosis" from the Histopathological Arthritis Registry of the German Society for Orthopedic Rheumatology were retrospectively examined, covering the period from 1 January 2018, to 31 December 2022.

RESULTS

Between 1 January 2018, and 31 December 2022, there were 14 cases of synovial chondromatosis out of a total of 13,222 cases in the Histopathological Arthritis Register of the German Society for Orthopedic Rheumatology. The available data include primary localization, and age and gender of the patients. Among the 13,222 cases in the Histopathological Arthritis Register of the German Society for Orthopedic Rheumatology, 14 were histopathologically confirmed as synovial chondromatosis. This resulted in a prevalence of 0.1% or 1.13 per 1,000 cases. The correct clinical presumptive diagnosis was made in 5 cases, yielding a sensitivity of 35.7%, 95% confidence interval (CI) 12.8% to 64.9%.

DISCUSSION

Differential diagnoses for this condition include pigmented villonodular synovitis, tenosynovial giant cell tumor, and chondrosarcoma. Synovial chondromatosis frequently occurs in large joints such as the knee, hip, and the temporomandibular joint. A peak incidence is described in the fifth decade of life. However, the disorder can also occur in children. For the first time, the study was able to provide data for Germany based on a large sample. Additionally, initial statements regarding the prevalence and sensitivity of synovial chondromatosis could be made. The aim of this work is to raise awareness of this very rare disease to enable faster and more efficient diagnosis. The study also highlights the importance of histopathology in the diagnosis of synovial chondromatosis.

Synovial Chondromatosis of the Knee Joint: Management With Arthroscopy-Assisted "Sac of Pebbles" Extraction and Synovectomy

Synovial chondromatosis is a rare, benign condition characterized by the formation of intra-articular cartilaginous loose bodies, which arise as a result of synovial membrane metaplasia. Due to pain, edema, and joint dysfunction, synovial chondromatosis can result in severe morbidity even though it is a self-limiting condition. In order to avoid problems, such as joint degeneration, early diagnosis and treatment is essential. This case study presents a female patient, age 24, who has experienced increasing pain, swelling, and occasional locking in her left knee for the past two years. Clinical examination of the suprapatellar pouch revealed several palpable loose bodies and effusion. Several intra-articular loose bodies were confirmed by imaging techniques. The patient underwent arthroscopic removal of multiple loose bodies and synovectomy. Histopathological examination confirmed the diagnosis as primary synovial chondromatosis. Postoperatively, the patient achieved a full range of movement without pain, and recurrence was not observed after three months of follow-up. For the treatment of knee synovial chondromatosis, an efficient and less invasive method is the arthroscopy-assisted removal of loose bodies and synovectomy. The value of this method in treating this uncommon condition is emphasized by the significant functional recovery and the lowered risk of recurrence.

De Novo Synovial Chondromatosis following Primary Total Knee Arthroplasty: A Case Report

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.

The 2020 World Health Organization classification of bone tumors: what radiologists should know

Improved understanding of tumor biology through molecular alteration and genetic advances has resulted in a number of major changes in the 2020 World Health Organization's (WHO) classification of bone tumors. These changes include the reclassification of the existing tumors and the introduction of several new entities. A new chapter on undifferentiated small round cell sarcomas of bone and soft tissue was added to classify Ewing sarcoma and the family of Ewing-like sarcomas, which share similar histologies but different molecular and clinical behaviors. Knowledge of the current classification of bone tumors is essential to ensure the appropriate recognition of the inherent biological potential of individual osseous lesions for optimal treatment, follow-up, and overall outcome. This article reviews the major changes to the 2020 WHO's classification of primary bone tumors and the pertinent imaging of selected tumors to highlight these changes.

The use of posteromedial portal for arthroscopic treatment of synovial chondromatosis of the knee: a case report

BACKGROUND

The synovial chondromatosis is an uncommon proliferative metaplastic process of the synovial cells that can develop in any synovial joint. An isolated primary chondromatosis of the posterior compartment of the knee is uncommon and few cases are reported in literature. Our purpose is to describe a rare case of primary chondromatosis of the knee posterior compartment and report the arthroscopic loose bodies excision through a difficult posteromedial portal, avoiding the use of the accessory posterior portal, most commonly reported for approaching this disease.

CASE PRESENTATION

We report a rare case of a 35-year-old Caucasian male patient with diagnosis of chondromatosis of the posterior knee compartment. The radiographs showed multiple loose bodies of the posterior compartment. The MRI revealed minimal synovial hypertrophy areas, multiple osteophytes in the intercondylar notch, and loose bodies in the posteromedial compartment. The CT allowed us to assess the bony structures, the morphology of the intercondylar notch, and the presence osteophytes of the medial and lateral femoral condyles. The CT images were crucial to plan how to reach the posterior compartments of the knee through a trans-notch passage. The patient underwent arthroscopic surgery using anteromedial, anterolateral, and posteromedial portals. The tunneling through the intercondylar osteophytes was performed to allow the arthroscope to pass trans-notch. To avoid additional accessory posterior portals, we used a 70° arthroscope to better explore the posterior knee compartment. The cartilage-like bodies were removed and synovectomy of the inflamed areas was performed. The clinical and radiological follow-up was 12 months and the patient showed excellent clinical outcomes, returning to his activities of daily living and sport activity.

CONCLUSION

Our case report highlights the importance of the arthroscopic approach to treat synovial chondromatosis, despite the involvement of the posterior compartment of the knee. An optimal preoperative imaging allows to plan for the proper surgical procedure even in patients with severe osteoarthritis. Moreover, the adoption of an intercondylar notch tunneling and a 70° arthroscope can help surgeons to better explore the posterior knee compartment, avoiding an accessory posterior trans-septal portal. Therefore, a synovectomy of the inflamed foci may be useful to prevent recurrence.

Evaluation and Management of Intra-Articular Tumors of the Knee

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.

Primäre synoviale Chondromatose

Hintergrund

Die primäre synoviale Chondromatose (SC) ist eine seltene Erkrankung der Synovialmembran unklarer Ätiologie. Der aktuelle Wissensstand zu dieser Erkrankung soll in einer kurzen Übersicht dargestellt werden.

Methoden

Übersichtsarbeiten und rezente Fallberichte zur SC wurden systematisch ausgewertet und mit Daten eigener Fälle in Kontext gesetzt.

Ergebnisse

Auf Grund neuer genomischer Daten wird die SC als benigne Neoplasie eingestuft. In 60 % der Fälle liegen Mutationen im Fibronektin-1-Gen (FN1) und/oder im Gen für den Activin-A-Typ-II-Rezeptor (ACVR2A) vor. Diagnoseweisend ist die Magnetresonanztomographie (MRT) und die meist arthroskopische Biopsie der Synovia. An einem Fallbeispiel soll gezeigt werden, dass die Knorpelaggregate der SC radiologisch nicht immer schattengebend sein müssen. Differenzialdiagnostisch kommen Monarthritiden anderer Ursachen, andere Gelenk- und Muskelerkrankungen mit Mineralisierung sowie weitere von der Synovialmembran ausgehende Erkrankungen in Betracht. Die Entartungsrate liegt bei 2–4 %. Therapeutisch hat sich in den letzten Jahren das arthroskopische Vorgehen durchgesetzt, das an die Ausdehnung der Erkrankung adaptiert wird.

Schlussfolgerung

Genomische Untersuchungen sowie Fallserien und Fallberichte aus jüngerer Zeit werfen ein neues Licht auf die SC. Therapeutisch wird in jüngeren Arbeiten überwiegend arthroskopisch vorgegangen.

Synovial chondromatosis of the distal radio-ulnar joint

Synovial chondromatosis (SC) is a benign metaplastic proliferation of cartilaginous nodules within the synovial membrane. Primary SC, though a rare monoarticular disease, significantly impacts patients' functional and pain-related outcomes. We outline the case of a 52-year-old man who presented with a large mass on the volar-ulnar aspect of his left wrist. Biopsy and workup revealed SC of the distal radio-ulnar joint. Though most cases of SC can be managed with arthroscopic or intralesional resection of the mass, a subset of extremely aggressive cases of SC may ultimately fail intralesional resection. Patients must be counseled about the possibility of amputation as an ultimate treatment option for the resolution of their pain and symptoms.

Systematic Arthroscopic Treatment of Synovial Chondromatosis of the Knee

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.

Clinical comparison of tenosynovial giant cell tumors, synovial chondromatosis, and synovial sarcoma: analysis and report of 53 cases

Background

Tenosynovial giant cell tumors (TGCTs), synovial chondromatosis (SC), and synovial sarcoma (SS) exhibit similarities in clinical features and histochemical characteristics, and differential diagnosis remains challenging in clinical practice.

Methods

Data were collected from the pathology database of Shanghai Ninth People's Hospital regarding patients who underwent surgery from 2010 to 2019 with histologically confirmed TGCTs, SC, and SS. Demographic and clinicopathological data of these patients were reviewed. Immunohistochemistry staining of 14 different markers was performed. Correlation analyses of the prognoses were evaluated.

Results

A total of 26 patients with TGCTs (8 diffuse TGCTs and 18 localized TGCTs), 16 with SC, and 11 with SS were identified. Pain was the main symptom of patients with both TGCTs and SC, while a palpable mass was the most common symptom for patients with SS. In addition to clinical features, we identified vital risk factors for disease recurrence. The mean follow-up periods were 51, 39, and 14 months for TGCTs, SC, and SS, respectively. Younger patients with diffuse TGCTs or patients with a higher neutrophil/lymphocyte ratio (NLR) displayed a significantly higher frequency of recurrence. We also plotted receiver operating characteristic (ROC) curve analysis for age and NLR. The area under the ROC curve (AUC) was calculated and demonstrated the ability to distinguish recurrent from nonrecurrent cases. In addition, higher CD163 expression was linked to recurrent diffuse TGCT cases.

Conclusions

These data indicated possible characteristics of different aspects of TGCTs, SC, and SS. Further clarification and understanding of these factors will help with differential clinical diagnosis and recurrent risk assessment.

A rare case of giant synovial osteochondromatosis of the thigh: A case report

RATIONALE

Giant synovial osteochondromatosis of the thigh is a highly unusual disease without standard diagnosis and curative managements so far. Our focus is to report a very rare case of giant synovial osteochondromatosis successfully operated by surgical treatment. The management of these unique cases has certain educational significance in clinical practice.

PATIENT CONCERNS

A 63-year-old previously healthy man presented to our institution with a 4-year history of continuous progressive hip pain and local numbness of right side in January 2018. One month ago, the patient felt that the above symptoms were aggravated, and the right hip and proximal thigh were significantly swollen.

DIAGNOSIS

Computed tomography and magnetic resonance imaging of the hip revealed the irregular mass in his right thigh. Post-operative pathology confirmed the diagnosis of synovial osteochondromatosis of the thigh.

INTERVENTIONS

Considering the large volume of the mass and possibility of malignancy, the patient underwent surgical exploration and complete tumor resection.

OUTCOMES

The patient's neurological deficits and symptoms improved significantly after the surgery, and the postoperative period was uneventful at the 1-year follow-up visit. There were no complications associated with the operation during the follow-up period.

LESSONS

Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Synovial osteochondromatosis of the thigh, although rare, should be part of the differential diagnosis when the patient presents with local pain, numbness, swelling or other symptoms. We recommend surgical treatment for the occupying lesion when the tumor has caused symptoms or neurological deficits.