Arthroscopic Treatment of Painful Hip in Associated with Ankylosing Spondylitis / 대한정형외과학회잡지

PURPOSE: To examine clinical outcomes of patients who have undergone arthroscopic treatment for hip pain in patients with ankylosing spondylitis. MATERIALS AND METHODS: Between April 2003 and May 2008, 9 early ankylosing spondylitis patients with hip pain who underwent hip arthroscopic treatment were analyzed retrospectively. Arthroscopic synovectomy was performed on all the patients and a spur resection was performed simultaneously on any patient showing osteophytes or spurs on their radiograph. The clinical results were assessed using the pain score and Harris hip score. RESULTS: All the patients showed normal to early arthritic changes except for 1 case in a hip simple radiograph and showed synovial hyperplasia in the arthroscopic findings. Seven patients showed specific spike-shaped spurs on the femoral head-neck junction. According to the pain score, the scores were 0.8 before surgery, 2.6 at 6 months postoperatively and 2.8 at the final follow-up. According to the Harris hip score, the scores were 47.4 before surgery, 87 at 6 months postoperatively and 91 at the final follow-up. CONCLUSION: Arthroscopic synovectomy and spur resection is a useful treatment for young adults with ankylosing spondylitis.

Diffuse Pigmented Villonodular Synovitis of the Knee: Case Report / 대한방사선종양학회지

Diffuse pigmented villonodular synovitis (PVNS) is an uncommon aggressive synovial proliferative disorder of unknown etiology affecting the joint linings. Though a histologically benign inflammatory process, because of its aggressive growth with bone destruction or recurrence, it is frequently suggested to occur as a low malignant neoplasm. Optimal treatment is surgery, but the local recurrence rate after radical synovectomy for diffuse PVNS is relatively high due to the infiltrative growth pattern. External beam radiotherapy with moderate doses or intra-articular instillation of radioactive isotopes may improve the likelihood of local control and long-term function in patients with incompletely resected or recurrent diffuse PVNS. I report one case of diffuse PVNS of the right knee joint treated with arthroscopic synovectomy and external beam radiotherapy is presented.

Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of arthroscopic synovectomy through the direct posterior-posterior approach in pigmented villonodular synovitis (PVNS) of the knee. MATERIALS AND METHODS: Between January 1997 and May 2004, twenty-one patients underwent an arthroscopic synovectomy for PVNS of knee. The mean follow-up period was 35 months. The arthroscopic and MRI findings revealed the localized form of PVNS in six patients and the diffuse form in fifteen patients. All patients underwent an arthroscopic examination and synovectomy through the direct posterior-posterior approach. The clinical results were evaluated by the range of motion, Lysholm knee score, and the knee pain score using the visual analogue scale (minimum 0-maximum 10). RESULTS: Among the fifteen cases with the diffuse form, three cases (14%) recurred and had secondary arthroscopic total synovectomy. One cases recurred again. Therefore, radiation therapy was performed. The Lysholm knee score improved from 62.5 to 87.3, and the VAS score improved from 5.9 to 1.8. Three patients had a mild limitation in knee motion. However, the others had full range of motion of the knee at the last follow-up. CONCLUSION: Arthroscopic synovectomy through the direct posterior-posterior approach could be a useful method for the treatment of PVNS of the knee, and can be used as an effective therapeutic tool particularly in posteromedial or posterolateral lesions.

Arthroscopic Synovectomy in the Rheumatoid Arthritis of the Knee Joint / 대한정형외과학회잡지

The short term beneficial effect of arthroscopic excision of synovial tissue in knees with rheumatoid arthritis have been well documented. The purpose of this study to report the results of synovectomy in patients with rheumatoid arthritis who have been observed at least 3 years. We analysed the clinical result with modified Laurin criteria, radiologic change and patients own satisfaction degree with survey. The results were as follows; 1. The preoperative symptoms were pain (100%), swelling (100%), decreased range of motion (83%) and joint tenderness (74%), and those were improved postoperatively to 43%, 60%, 11%, 43% each other. 2. Among the laboratory parameters, C-reactive protein (CRP) was improved most significantly (pvalue =0.026). 3. On simple supine A-P X-rays, the width of medial joint space and lateral joint space were compared to preoperatively and postoperatively. The width of medial joint space was 4.33mm preoperatively, and it was changed to 3.22mm at last follow up (p=0.032). Those of lateral joint space was changed from 4.24mm preoperatively to 3.27mm at last tollow up (p=0.106). 4. The grade of articular cartilage damage was related with severity of preoperative symptoms and the patients with low grade of articular cartilage damage showed more postoperative improvement. The result of operation was related to symptom duration, degree of X-ray change and degree of cartilage damage. 5. 58% ot patients were satisfied to results of synovectomy, 28% were answered neither satisfied nor ansatisfied and 14% were unsatisf'ied to operation. We concluded the arthroscopic synovectomy of the knee joints was effective procedure to improve the clinical symptoms, range of knee motion and to alleviate the inflammatory reaction at mid-term period al'ter the operation. So we consider this procedure is a palliative treatment that modified and alleviate the progression of rheumatoid arthritis of knee joints.

Arthroscopic Synovectomy on Knee Joint

The results of arthroscopic synovectomy of the knee joints were reviewd in 23 joints of 21 patients hetween May 1992 and June 1996. The results were as follows: 1. Pain, tenderness, swelling, ROM of synovitis syrnpknns were much nsiproved postoperatively. 2. The degrees of articular cartilage damage were closely related to posto-perative functional recovery. 3. Preoperative and postoperative ESR changes were not ditferent signihcantly, 4. Recurrence rate was 17%, 4 cases. Of them, 2 cases were rheumatoid arthritis, 1 case was pigmented villonodular synovitis, I case was nonspecipic synovitis 5. Complicatior of arthrosc:opic synovectomy was nol found. We concluded that arthroscopic synovectoiny was very useful method of early diagnosis and treatment of synovial memhrane diseases.

Effect of Synovectomy on Prognsis of Rheumatoid Arthritis / 대한정형외과학회잡지

This is a long term follow-up study to clarify whether arthroscopic synovectomy would be able to prevent further destruction of the articular cartilage in rheumatoid joints. Three hundred and eighteen rheumatoid joints of 94 patients who had surgery in the multiple joints(average 3.4 joints per person) and was followed for an average 39.9 months (range, 24-126 months) were selected. Diagnosis of rheumatoid arthritis was made according to the 1987 revised criteria of the American College of Rheumatology. The preoperative roentgenographic narrowing of cartilage space (modified classification of ARA) and the arthroscopic findings (grading of Outerbridge) were recorded. The points of investigation were 1) further destruction of articular cartilage on X-ray, postoperatively, and 2) reaccumulation of effusion. The results were as follows; 1) Knee Joint: Among 103 knee joints there were 92 (89.3%) Stage I, G-0 knees, 8 Stage II (G-2: 1, G-3: 3, G-4: 4 joints), and 3 Stage IIIB, G-4, preoperatively. The 3 Stage IIIB, G-4 knees showed progression of narrowing of joint space and were replaced by artificial joints two years after the synovectomy. 2) Wrist joint: Fifteen joints (28.3%) out of 53 joints were Stage II, G-4, and 2 joints joints (3.8%) were Stage I, G-3, preoperatively. They were progressed to Stage IIIB at final follow-up. 3) Other Joints: There was no further narrowing of the joint space following surgery in 22 fingers, 2 toes, 34 elbows, 34 shoulders and 70 ankles. 4) Prognosis seemed to depend upon postoperative medication. From these results it would be suggested that the rate and severity of recurrence of synovitis and further destruction of articular cartilage can be decreased with early synovectomy so long as proper anti-rheumatic medication is followed, although the surgery can not halt the disease process.

Arthroscopic Synovectomy in Wrist / 대한정형외과학회잡지

The application of arthroscopic surgery in wrist is not widely advocated because of technical difficulty. We analysed 11(10 patients) wrists of which were performed arthroscopic synovectomy in wrist from July 1991 to September 1992 in Kyung Hee University Hospital. The age of the patients ranged from 23 to 55 years old. Follow up period was from 12 months to 26 months. The application for the arthroscopic synovectomy in that group of patients were based on such disabling clinical symptoms as severe pain, swelling, limitation of range of motion and roentgenographic type from mild to severe stage. Postoperative diagnosis was histologically confirmed with rheumatoid arthritis in nine wrists (nine patients) and gout in two wrists (one patient). The results were assessed subjectively and objectively with pain, swelling and range of motion. Satisfactory overall results were obtained and there were no complications. Conclusively, arthroscopic synovectomy in the wrist is effective produce to relieve pain of the rheumatoid arthritis and gout but arthroscopic synovectomy of wrist is technically demanded.

Arthroscopic Synovectomy of the Knee Joint / 대한정형외과학회잡지

A follow-up study was made of 26 knees of 21 patients who underwent arthroscopic synovectomy between October 1982 and August 1983 in Catholic Medical College and Center. The patient's ages ranged from 3 to 66 years of age. There were 14 female patients and 7 male patients in this series. The follow-up period of all patients was a minimum of twelve months to a maximum of 20 months. The average follow-up of the whole group was 16.8 months. The abnormal findings were rated from 0 to 4 according to Marmors rating system. Final clinical evaluations of the patients were done according to the modified criteria of Sledge et al. The results were as follows; 1. Rheumatoid Arthritis Of 14 knees, 3 joints(21.4%) were rated “excellent”, 6(42.9%) were “good”, and 5(35.7%) were “fair”. There was no case of “unimproved”. 2. Juvenile Rheumatoid Arthritis The results of all 5 knees were satisfactory. Of 5 knees, 4 joints(80%) were rated excellent and one joint (20%) was good. 3. There were 3 knees of osteoarthritis, 3 knees of chronic synovitis and one knee of pigmented villonodular synovitis. Their final results were all satisfactory. Three joints were rated excellent and the other 3 joints were good. 4. Of 26 knees, as a whole, 10 joints (38.5%) were rated “excellent”, 11 joints (42.3%) were “good”, 5 joints (19.2%) were “fair” and no joint was “unimproved”. There were 5 recurrences of active synovial disease in this series, and these patients all were “classic” rheumatoid arthritis. But surprisingly the average patient in this group of recurrence did well even after recurrence. These patients all had less pain and effusion than before operation. 5. The major cause of unsatisfactory results other than recurrence of synovitis were articular degeneration (joint space narrowing) and patellofemoral osteoarthritis (4 knees). 6. A good range of motion with the shortest rehabilitation period can be expected if alternate flexion and extension splints are applied on alternate days for less than a week following the surgery. In conclusion, one may state that the arthroscopic synovectomy is worth considering for the treatment of various kinds of synovitis of the knee joint and when the rheumatoid process follows a favourahle course.