1
|
Aljasim O, Vahabi A, Biçer MEK, Taşkıran E. Synovectomy induced patellar tendon ossification in patient with rheumatoid arthritis: A case report and review of the literature. Int J Surg Case Rep 2023; 110:108574. [PMID: 37574628 PMCID: PMC10448270 DOI: 10.1016/j.ijscr.2023.108574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Patellar tendon ossification is a rare complication that primarily occurs following a knee injury. This article aims to describe, for the first time, a case of patellar tendon ossification following synovectomy. CASE PRESENTATION A 48-year-old male with a diagnosis of rheumatoid arthritis presented with swelling in his left knee following a synovectomy procedure. After a thorough physical examination, radiographic assessment, and computed tomography, the patient was diagnosed with total patellar tendon ossification. Subsequently, the patient underwent excision of the ossified mass and tendon reconstruction using an Achilles allograft. DISCUSSION The primary causes of patellar tendon ossification are iatrogenic and traumatic injuries. The presence of rheumatoid arthritis, which negatively affects tissue healing, may exacerbate this condition. Smaller lesions can be managed conservatively or through resection and repair. In cases of extensive ossification, resection and reconstruction are necessary. A comprehensive literature review is also provided. CONCLUSION The occurrence of patellar tendon swelling following trauma or surgery should raise suspicion of patellar tendon ossification. Rheumatoid arthritis is a risk factor for the development of patellar tendon ossification. In cases of extensive ossification, successful treatment can be achieved through reconstruction using an Achilles allograft.
Collapse
Affiliation(s)
- Omar Aljasim
- Department of Orthopedic Surgery, Gebze Medikal Park Hospital, Kocaeli, Turkey.
| | - Arman Vahabi
- Department of Orthopedic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | | | - Emin Taşkıran
- Department of Orthopedic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| |
Collapse
|
2
|
d'Ailly PN, Mulders MAM, Bisoendial RJ, Kuijper TM, Coert JH, Schep NWL. Arthroscopic Synovectomy of the Wrist in Patients With Rheumatoid Arthritis: A Systematic Review of the Current Literature. J Clin Rheumatol 2022; 28:77-83. [PMID: 34897196 DOI: 10.1097/rhu.0000000000001807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) of the wrist can lead to loss of wrist function and progressive joint destruction if inadequately treated. Arthroscopic synovectomy of the wrist may prove a valuable treatment for local inflammation. OBJECTIVE The aim of this study was to perform a systematic review evaluating functional outcomes and pain following arthroscopic synovectomy of the wrist in RA patients. METHODS A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. MEDLINE, EMBASE, The Cochrane Library, Web of Science, and Google Scholar were searched for studies describing pain or functional outcomes following arthroscopic synovectomy of the wrist in RA patients (CRD42021270846). Risk of bias was assessed using the Methodological Index for Non-Randomized Studies. Data collection included patient characteristics, pain scores, wrist function questionnaires, secondary surgery, and complications. RESULTS Six noncomparative cohort studies were included, with a total of 153 arthroscopic synovectomies. Disease duration of RA ranged from 32 to 89 months, and radiographic progression was mild to moderate. The Methodological Index for Non-Randomized Studies scores ranged from 8 to 10 out of 16. Mean follow-up ranged from 21 to 95 months. Improvements were seen in pooled mean visual analog scale pain score (from 7.7 to 2.2, p < 0.05), pooled mean Modified Mayo Wrist Score (from 43.3 to 70.4, p < 0.05), and the Disability of the Arm, Shoulder, and Hand (from 67.5 to 36.5, p < 0.05). Two complications occurred, and 5 patients required secondary surgery. CONCLUSIONS There is limited evidence suggesting that arthroscopic synovectomy of the wrist improves wrist function and pain in patients with RA, with few complications. In centers with arthroscopic expertise, it can be considered as a treatment option.
Collapse
Affiliation(s)
| | | | - Radjesh J Bisoendial
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam
| | - T Martijn Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam
| | - J Henk Coert
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Niels W L Schep
- From the Department of Surgery, Maasstad Hospital, Rotterdam
| |
Collapse
|
3
|
Sullivan MM, Pham MM, Marks LA, Aslam F. Intra-articular therapy with methotrexate or tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic review. BMC Musculoskelet Disord 2021; 22:792. [PMID: 34525992 PMCID: PMC8444402 DOI: 10.1186/s12891-021-04651-5] [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: 05/15/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Persistent monoarthritis in otherwise well-controlled rheumatoid arthritis presents a therapeutic challenge. Intra-articular (IA) steroids are a mainstay of treatment, though some have queried whether IA disease modifying anti-rheumatic drugs (DMARD) and biologics can be used in those who fail steroid injections. Methods A systematic literature review was conducted using four medical databases to identify randomized, controlled trials assessing IA therapies in RA patients. Included studies underwent Cochrane Risk of Bias 2 assessment for quality. Results Twelve studies were included, 6 of which examined intra-articular (IA) TNF inhibitors (TNFi), and 6 studies evaluating IA methotrexate. Of those evaluating IA TNFi, one study reported statistical improvement in TNFi therapy when compared with placebo. The remaining 5 studies compared IA TNFi therapy with steroid injections. IA TNFi had statistically improved symptom scores and clinical assessments comparable with IA steroid treatments. In the 6 studies evaluating IA methotrexate, the addition of methotrexate to steroid intra-articular therapy was not found to be beneficial, and singular methotrexate injection was not superior to the control arms (saline or triamcinolone). Risk-of-bias (ROB) assessment with the Revised Cochrane ROB tool indicated that 2 of 6 TNFi studies were at some risk or high risk for bias, compared with 5 out of 6 methotrexate studies. Conclusion For persistent monoarthritis in rheumatoid arthritis, IA methotrexate was not found to have clinical utility. Intra-articular TNFi therapy appears to have equal efficacy to IA steroids, though the optimal dose and frequency of injections is yet unknown. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04651-5.
Collapse
Affiliation(s)
- Megan M Sullivan
- Division of Rheumatology, Department of Internal Medicine Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Michael M Pham
- Division of Rheumatology, Department of Internal Medicine Mayo Clinic, Scottsdale, AZ, USA
| | - Lisa A Marks
- Mayo Clinic Libraries Arizona, Mayo Clinic, Scottsdale, AZ, USA
| | - Fawad Aslam
- Division of Rheumatology, Department of Internal Medicine Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
4
|
Ayik O, Demirel M, Turgut N, Altas O, Durmaz H. Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results. J Wrist Surg 2021; 10:280-285. [PMID: 34381629 PMCID: PMC8328547 DOI: 10.1055/s-0040-1722570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21-45). The mean follow-up period duration was 36 months (range: 18-60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31-52) and 7.1 (range: 6-8) preoperatively to 13 (range: 8-21) and 2 (range: 0-3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20-60 degrees) and 56 degrees (range: 30-70 degrees; p = 0.009) preoperatively to 34 (range: 10-65 degrees; p = 0.218) and 57 degrees (range: 30-70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9-33) to 23.3 (range: 10-34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.
Collapse
Affiliation(s)
- Omer Ayik
- Department of Orthopedics and Traumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopedics and Traumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Necmettin Turgut
- Department of Orthopedics and Traumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Okyar Altas
- Department of Orthopedics and Traumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Hayati Durmaz
- Department of Orthopedics and Traumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
5
|
Rydholm M, Wikström I, Hagel S, Jacobsson LTH, Turesson C. The relation between upper extremity joint involvement and grip force in early rheumatoid arthritis: a retrospective study. Rheumatol Int 2019; 39:2031-2041. [PMID: 31494739 DOI: 10.1007/s00296-019-04438-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022]
Abstract
To investigate the relation between joint involvement in the upper extremities and grip force in patients with early rheumatoid arthritis (RA). An inception cohort of 225 patients with early RA was followed according to a structured protocol. The same rheumatologist assessed all patients for swollen joints and joint tenderness. Grip force was measured (Grippit; AB Detektor, Gothenburg, Sweden) at the same visit. Average grip force values for the dominant hand were expressed as % of expected, based on age- and sex-specific reference values from the literature. Associations between grip force and current synovitis or tenderness of individual joints, and other disease parameters measured at the same visit, were examined. Patients with current synovitis of the wrist joint or ≥ 1 metacarpophalangeal (MCP) joint of the dominant hand had a significantly lower grip force at inclusion, at 1 year and at 5 years. Proximal interphalangeal joint tenderness and MCP joint tenderness were consistently associated with reduced grip force. In multivariate analysis, extensive MCP joint synovitis was associated with lower grip force at inclusion (β - 2.8% per joint; 95% CI - 5.3 to - 0.4), and also at the 1-year follow-up. Patient reported pain scores and erythrocyte sedimentation rates had independent negative associations with grip force at all time points. In patients with early RA, extensive synovitis of the MCP joints was associated with reduced grip force, independently of other upper extremity joint involvement. Pain and inflammation have effects on hand function beyond those mediated by local synovitis.
Collapse
Affiliation(s)
- Maria Rydholm
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Ingegerd Wikström
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Sofia Hagel
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden.,Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lennart T H Jacobsson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
| |
Collapse
|
6
|
Holden NE, Coplen TB, Böhlke JK, Tarbox LV, Benefield J, de Laeter JR, Mahaffy PG, O’Connor G, Roth E, Tepper DH, Walczyk T, Wieser ME, Yoneda S. IUPAC Periodic Table of the Elements and Isotopes (IPTEI) for the Education Community (IUPAC Technical Report). PURE APPL CHEM 2018. [DOI: 10.1515/pac-2015-0703] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
The IUPAC (International Union of Pure and Applied Chemistry) Periodic Table of the Elements and Isotopes (IPTEI) was created to familiarize students, teachers, and non-professionals with the existence and importance of isotopes of the chemical elements. The IPTEI is modeled on the familiar Periodic Table of the Chemical Elements. The IPTEI is intended to hang on the walls of chemistry laboratories and classrooms. Each cell of the IPTEI provides the chemical name, symbol, atomic number, and standard atomic weight of an element. Color-coded pie charts in each element cell display the stable isotopes and the relatively long-lived radioactive isotopes having characteristic terrestrial isotopic compositions that determine the standard atomic weight of each element. The background color scheme of cells categorizes the 118 elements into four groups: (1) white indicates the element has no standard atomic weight, (2) blue indicates the element has only one isotope that is used to determine its standard atomic weight, which is given as a single value with an uncertainty, (3) yellow indicates the element has two or more isotopes that are used to determine its standard atomic weight, which is given as a single value with an uncertainty, and (4) pink indicates the element has a well-documented variation in its atomic weight, and the standard atomic weight is expressed as an interval. An element-by-element review accompanies the IPTEI and includes a chart of all known stable and radioactive isotopes for each element. Practical applications of isotopic measurements and technologies are included for the following fields: forensic science, geochronology, Earth-system sciences, environmental science, and human health sciences, including medical diagnosis and treatment.
Collapse
Affiliation(s)
- Norman E. Holden
- National Nuclear Data Center, Brookhaven National Laboratory , Upton, NY , USA
| | | | | | | | | | | | | | | | - Etienne Roth
- Commissariat à l’énergie atomique (CEA) , Gif-sur-Yvette, France
| | | | - Thomas Walczyk
- Department of Chemistry , National University of Singapore , Singapore , Singapore
| | - Michael E. Wieser
- Department of Physics and Astronomy , University of Calgary , Calgary , Canada
| | | |
Collapse
|
7
|
Rehart S, Henniger M. [Surgery for inflammatory rheumatic joint destruction]. DER ORTHOPADE 2018; 47:935-940. [PMID: 30357427 DOI: 10.1007/s00132-018-03657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Orthopaedic and traumatologic involvement in patients with rheumatic diseases require extensive knowledge of these immunologically impairing illnesses. This concerns both the handling of medication and conservative treatment. The destructive processes of the joints and the spine follow established pathways. Various operating procedures are helpful depending on the stage of articular destruction. The special features of the entire perioperative management of affected persons has to be observed. Soft tissue surgical interventions are followed by arthrodesis or arthroplasty in later courses of destruction. In Germany, the orthopaedic rheumatologist specializes in the conservative and surgical treatment of inflammatory systemic diseases. Audited centres for operative interventions of the German Society for Orthopaedic Rheumatology (DGORh) seem to be the best fit for this purpose.
Collapse
Affiliation(s)
- S Rehart
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Rheumatologie, AGAPLESION MARKUS KRANKENHAUS, Akademisches Lehr-KH der Goethe-Universität, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland.
| | - M Henniger
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Rheumatologie, AGAPLESION MARKUS KRANKENHAUS, Akademisches Lehr-KH der Goethe-Universität, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland
| |
Collapse
|
8
|
Vermaak PV, Southwood TR, Lindau TR, Jester A, Oestreich K. Wrist Arthroscopy in Juvenile Idiopathic Arthritis: A Review of Current Literature and Future Implications. J Wrist Surg 2018; 7:186-190. [PMID: 29922493 PMCID: PMC6005783 DOI: 10.1055/s-0038-1639508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
Introduction Juvenile Idiopathic Arthritis (JIA) is the most common rheumatological condition in children and frequently affects the wrist. The roles for wrist arthroscopy and arthroscopic synovectomy (AS) in JIA are unclear. Our aim was to find the current evidence supporting its use. Methods Systematic literature review of relevant publications from 1990 to present in the Cochrane Library, Clinical Knowledge Summaries, DynaMed, PEMSoft, NICE Guidance, MEDLINE, EMBASE, and PubMed. Results We found no publications detailing the use of arthroscopy or AS specifically in patients with JIA involving the wrist. There is evidence that AS reduces pain, improves function, and induces remission in patients with rheumatoid arthritis resistant to medical management. Discussion and Conclusion Although there is paucity in evidence for the use of AS in the wrists of patients with JIA, studies suggest it to be safe and effective, and could be applied to patients with refractive JIA. It is possible that early identification of patients suffering from JIA with extensive joint destruction and little symptoms could benefit from AS, delaying joint destruction and preserving function.
Collapse
Affiliation(s)
- P. V. Vermaak
- Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - T. R. Southwood
- Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | | | - A. Jester
- Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - K. Oestreich
- Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| |
Collapse
|
9
|
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist.
Collapse
|
10
|
Sharif K, Sharif A, Jumah F, Oskouian R, Tubbs RS. Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view. Clin Anat 2017; 31:216-223. [PMID: 28833647 DOI: 10.1002/ca.22980] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 02/01/2023]
Abstract
Rheumatoid arthritis (RA) is the most common chronic autoimmune disease of the joints affecting close to 0.5-1.0% of the general population. Although the etiopathogenesis of RA remains elusive, the involvement of dendritic cells and type 17 T-helper cells appears to be pivotal in maintaining a state of chronic inflammation. RA is generally characterized by small joint involvement. A chronic inflammatory process leads to joint destruction and to tendon and ligament laxity and disintegration. These processes result in an imbalance of forces acting on the joints causing joint deformities including swan neck deformity, boutonniere deformity of the hands, flexion deformity of the wrist, lesser toe deformities, and others. In some instances, bony erosions subsequent to the RA disease process can result in life-threatening events including, for example, atlanto-axial subluxation, which can cause myelopathy and paralysis; and basilar invagination, which can cause brain stem injury and imminent death. Although less commonly involved, larger joints are not spared, as evidenced by the involvement of the elbow, hip, and shoulder joints in a sizable proportion of RA patients. The progression and prognosis of this disease entity are variable, guarded and dependent on the efficacy and response to treatment modalities employed. Inadequate management results in disease progression, which ultimately leads to joint erosion, destruction, deformities and substantial decrease in the functional quality of life. Clin. Anat. 31:216-223, 2018. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Kassem Sharif
- Department of Medicine 'B' Sheba Medical Center, Tel-Hashomer Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alaa Sharif
- Department of Medicine 'B' Sheba Medical Center, Tel-Hashomer Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Fareed Jumah
- Department of Neuroscience, an-Najah National University Hospital, Nablus, Palestine
| | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Grenada
| |
Collapse
|
11
|
Hariri A, Lebailly F, Zemirline A, Hendriks S, Facca S, Liverneaux P. Contribution of arthroscopy in case of septic appearance arthritis of the wrist: A nine cases series. ACTA ACUST UNITED AC 2013; 32:240-4. [DOI: 10.1016/j.main.2013.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/04/2013] [Accepted: 05/15/2013] [Indexed: 11/26/2022]
|
12
|
Chung CYS, Yen CH, Yip MLR, Koo SCJJ, Lao WNV. Arthroscopic synovectomy for rheumatoid wrists and elbows. J Orthop Surg (Hong Kong) 2012; 20:219-23. [PMID: 22933683 DOI: 10.1177/230949901202000217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the treatment outcome of wrist and elbow arthroscopic synovectomy for patients with rheumatoid arthritis. METHODS 3 men and 18 women aged 27 to 71 (mean, 54) years underwent arthroscopic synovectomy for rheumatoid arthritis of the wrist (n=12) and elbow (n=13). All patients had received multiple medications including non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and steroids, as well as physiotherapy and splintage for 6 months, but the joint pain and disability persisted. The median duration of rheumatoid arthritis was 89 (range, 24-156) and 108 (range, 36-360) months for the wrist and elbow joints, respectively. According to the Larsen grading, the radiographic stages of the wrists and elbows were classified as grade 1 (n=4+4), grade 2 (n=4+5), and grade 3 (n=4+4). Visual analogue scale for pain, the wrist and elbow flexion-extension arcs, grip strength, key pinch strength, inflammatory markers, disability and symptoms were compared pre- and post-operatively. RESULTS The median follow-up period was 30 (range, 18-78) and 34 (range, 18-78) months for wrists and elbows, respectively. There was significant improvement in pain, joint motion, inflammatory markers, and disability score. All patients were satisfied with the surgery. There was no neurovascular or wound complication. No patient was taking longterm pain-control drugs. One patient underwent a second arthroscopic synovectomy after 15 months owing to exacerbation of arthritis. CONCLUSION Arthroscopic synovectomy is recommended for patients with rheumatoid arthritis who fail conservative treatment.
Collapse
|
13
|
Abstract
Previous studies have shown large variation in the rate of common surgical procedures performed for the rheumatoid hand. This article provides a comprehensive overview of each surgical treatment option for rheumatoid hand reconstruction.
Collapse
Affiliation(s)
- Shimpei Ono
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA
| | | | | |
Collapse
|
14
|
Goetz M, Klug S, Gelse K, Swoboda B, Carl HD. Combined arthroscopic and radiation synovectomy of the knee joint in rheumatoid arthritis: 14-year follow-up. Arthroscopy 2011; 27:52-9. [PMID: 20950987 DOI: 10.1016/j.arthro.2010.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Revised: 05/26/2010] [Accepted: 06/03/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the long-term outcome of combined arthroscopic and radiation synovectomy of the knee joint in early cases of rheumatoid arthritis (RA) with regard to knee function and the need for surgical re-interventions. METHODS Between 1993 and 1997, a consecutive series of 38 RA patients with therapy-refractory synovitis of the knee joint and only mild cartilage lesions (not exceeding Outerbridge grade II at surgery) were treated with combined arthroscopic and radiation synovectomy. Knee function was assessed preoperatively; at 6 months, 1 year, and 5 years; and finally, at a mean of 14 years with 4 different functional scores. A Kaplan-Meier survival curve was calculated with "any re-intervention" and "total knee arthroplasty" as endpoints. RESULTS Of 38 knees, 32 were available for the final 14-year follow-up with a total of 22 re-interventions: intra-articular steroid injection (n = 3), arthroscopic (n = 2) or radiation (n = 1) re-synovectomy, and total knee arthroplasty (n = 16). The remaining 10 patients with no re-intervention showed knee function not significantly different from the postoperative state. With any surgical re-intervention as the endpoint, the survival rate was 84% at 5 years (95% confidence interval [CI], 67.0% to 86.7%), 44% at 10 years (95% CI, 26.7% to 60.0%), and 32% at the 14-year assessment (95% CI, 16.0% to 49.3%). With total knee arthroplasty as the endpoint, the joint survival rate was 88.5% at 5 years (95% CI, 68.5% to 96.2%), 53.9% at 10 years (95% CI, 33.3% to 71.6%), and 39.6% at 14 years (95% CI, 18.9% to 48.6%). CONCLUSIONS Combined arthroscopic and radiation synovectomy leads to a stable improvement of knee function for a minimum of 5 years, but surgical re-interventions were frequently observed at the 14-year assessment and challenge the long-term benefit of the procedure. Patients with no interventions had a significantly shorter history of disease (7 v 11 years). LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Martin Goetz
- Division of Orthopedic Rheumatology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | |
Collapse
|
15
|
Abstract
Arthroscopic synovectomy in rheumatoid arthritis has proven beneficial in terms of pain relief and joint function, both for upper limb joints (shoulder, elbow, wrist) and the knee. The clinical long-term improvement, such as pain reduction and improved joint mobility, seems more distinct in joints with no or mild joint destruction (early synovectomy) compared to advanced joint damage (late synovectomy). Late-stage elbow arthritis, synovitis of the metacarpophalangeal and proximal interphalangeal joints and the rheumatoid ankle can better be addressed by an open approach. Although a real joint-preserving effect has not been demonstrated, pain reduction and improvement in joint function recommend arthroscopic synovectomy as a substantial treatment option in patients with rheumatoid arthritis.
Collapse
|