Influência do tratamento fisioterapêutico na independência funcional de pessoas com hemofilia submetidas à sinovectomia radioativa / Influence of physiotherapeutic treatment on the functional independence of people with hemophilia submitted to radioactive sinovectomy

A sinovectomia radioativa (SR) é considerada o tratamento de eleição no controle da sinovite crônica não responsiva ao tratamento conservador, sendo recomendado tratamento fisioterapêutico para a melhora da funcionalidade. Objetivo: Verificar a influência do tratamento fisioterapêutico na independência funcional e saúde articular de hemofílicos após tratamento com SR. Método: Trata-se de um estudo descritivo, retrospectivo, analítico e metodologia quali-quantitativa. Realizou-se avaliação fisioterapêutica, aplicação do HJHS para avaliação da saúde articular e Escore FISH para avaliação da independência funcional. Os participantes foram subdivididos em dois grupos de acordo com a realização ou não da fisioterapia após a SR. Resultados: Participaram do estudo 8 pessoas com hemofilia A, sexo masculino, média de idade de 19±5,3 anos. Foram 12 articulações submetidas a SR, dessas 41,67% cotovelos, 33,33% joelhos e 25% tornozelos. Na comparação dos grupos, não houve diferença estatística entre os eles nas variáveis: saúde articular e a Independência Funcional. Conclusão: O estudo é uma primeira tentativa de descrever o impacto da fisioterapia na independência funcional e saúde articular de hemofílicos submetidos à SR. Embora possua limitações, foi possível observar que o grupo que não realizou fisioterapia apresentava melhor saúde articular e melhor independência funcional previamente à SR em comparação ao grupo que realizou fisioterapia; porém, o grupo fisioterapia apresentava pior quadro global, com a funcionalidade impactada por outras articulações e não somente aquela tratada com SR, apresentando maior número de articulações alvo.

Radioactive synovectomy (RS) is considered the treatment of choice in the control of chronic synovitis resistant to conservative treatment, and physiotherapy is recommended to improve functionality after procedure. Objective: The aim was to verify the effects of physiotherapy on functional independence and joint health after RS. Method: This is a descriptive, retrospective, analytical study with qualitative/quantitative methodology. Physiotherapeutic evaluation, Hemophilia Joint Health Score (HJHS) application for joint outcome assessment and Functional Independence Score in Hemophilia (FISH) were used to measure the patient's functional ability. The participants were divided into two groups: one group underwent a physiotherapy program and one not treated with physiotherapy after RS. Results: The study included 8 people with hemophilia A, all male, their mean age was 19±5.3 years. Twelve joints were submitted to RS, in which 41.67% elbows, 33.33% knees and 25% ankles. In the comparison of the groups, there was no statistically significant difference between them in joint health and functional independence. Conclusion: The study is a first attempt to describe the impact of physiotherapy on functional independence and joint health of hemophilic patients submitted to SR. Although this study has limitations, it was possible to observe that the group not treated with physiotherapy had better joint health and better functional independence prior to SR compared to the group that underwent physiotherapy, but the group treated with physiotherapy had worse overall health and have their functionality impacted by joints other than those treated with RS, presenting a higher number of target joints.

Radioterapia en tumor de células gigantes tenosinovial (sinovitis villonodular pigmentada) / Radiation therapy in tenosynovial giant cell tumor (pigmented villonodular synovitis)

Presentar nuestra experiencia de 18 años en el tratamiento con radioterapia y evaluar cifras de control tumoral local en pacientes con diagnóstico de tumor de células gigantes tenosinovial difuso sinovitis villonodular pigmentada difusa. 33 pacientes, tratados durante el período 2000-2018. En 19 (57,6 %) se practicó sinovectomía parcial, 10 (30,3 %) fueron tratados con artroplastia y sinovectomía, 4 (12,2 %) con sinovectomía total. 32 pacientes recibieron radioterapia posoperatoria, 1 paciente preoperatoria. Técnica más empleada fue planificación 2D 51,5 % seguida de conformada con planificación 3D (RTC3D) 48,5 %. La dosis total promedio administrada 44 Gy (rango 10,5 - 50). Tiempo promedio de tratamiento radiante 28 días (8-35). Tiempo de seguimiento entre 0,7 - 240,8 meses, mediana 12 meses, promedio 52,1 meses. 26 pacientes (79 %) presentaron mejoría de la sintomatología inicial y 6 (18 %) refirieron estabilidad de los síntomas. La respuesta clínica al tratamiento en relación al tiempo de seguimiento, 12 pacientes (36,4 %) estaban asintomáticos, 10 con un seguimiento mayor a 60 meses; 14 (42,4 %) refieren respuesta clínica satisfactoria, (2 con un seguimiento mayor a 60 meses) 6 pacientes presentaban enfermedad estable, para un control local del 97 %. El 87,9 % presentaron dermatitis grado I, 1 desarrolló dermatitis grado II, 3 no presentaron efectos adversos. La radioterapia es una modalidad de tratamiento muy efectiva como adyuvante a la sinovectomía, observándose altas tasas de control local de la enfermedad con una baja morbilidad(AU)

To report our eighteen-year experience with radiation therapy in the treatment of diffuse tenosinovial giant cell tumor / diffuse pigmented villonodular synovitis and to assess local control of the disease. A review of 33 patients with treated with radiation therapy during the period 2000-2018 was done. 19 (57.6 %) partial synovectomy was performed, 10 (30.3 %) underwent arthroplasty plus synovectomy, 4 (12.2 %) total synovectomy. 32 patients received radiotherapy postoperative and 1 pre-operative. Most common technique employed was conventional (2D) in 51.5 % and 3D conformal (3DCRT) in 48.5 %. The average total dose was 44 Gy (range 10.5-50), with a mean treatment time of 28 days (8-35). Follow-up time ranged from 0.7- 240.8 months, median time and mean time of 12 and 52.1 months respectively After RT 26 (79 %) of the patients obtained improvement of the initial symptoms and 6 (18 %) were stable. 12 patients (36.4 %) were asymptomatic with follow-up time longer than 36 months (10 of 12 had follow-up time >60 months), 14 (42.4 %) had significant clinical improvement (2 of 14 had follow-up time >60 months), and 6 had stable disease, local control of 97 %. Complications were few, acute skin toxicity was grade I in 29 (87.9%) and grade II in 1 patient. There was no significant chronic toxicity. Radiation therapy is an effective adjuvant treatment modality after synovectomy in patients with high local control rates and low morbidity(AU)

Surgical Treatment for Diffuse Pigmented Villonodular Synovitis of the Ankle by A Combined Open and Arthroscopic Synovectomy: A Case Report / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease involving the synovial membranes. Complete excision with a total synovectomy is important for diffuse type PVNS because of its high recurrence rate. In the ankle, complete excision of diffuse type PVNS is difficult due to the anatomical structure of the ankle joint. This paper reports the author's experience of surgical treatment with combined open and arthroscopic synovectomy. In this manner, it is expected that the complications of the open procedure and the recurrence rate of arthroscopic procedure can be reduced.

The effect of arthroscopic synovectomy on refractory knee arthritis with popliteal cyst in 153 patients / 中华内科杂志

Objective To investigate the efficacy of arthroscopic synovectomy on refractory knee arthritis complicated with popliteal cyst.Methods Patients diagnosed as rheumatoid arthritis (RA) or spondyloarthritis (SPA) with refractory knee arthritis who underwent knee arthroscopic synovectomy in our hospital from 2010 to 2017 were enrolled,including 20 patients (16 RA,4 SpA) with popliteal cyst.Clinical data,RA disease activity score (DAS28),SpA back pain score,etc,were collected to evaluate the efficacy of knee surgery.Results Erythrocyte sedimentation rate (ESR) [58(17,79)mm / 1h vs.19(9,30)mm/1h,P＜ 0.001],C reactive protein (CRP) [3.72(0.92,8.14) mg/L vs.0.85(0.10,3.08) mg/L,P＜0.001],rheumatoid factor [64.6(20.2,193.3) vs.20.5(10.0,58.4),P＜0.001],DAS28 score(4.67±1.25 vs.2.81±1.23,P＜0.001),knee joint discomfort score [5(4,6) vs.2(1,3),P＜0.001] and the volume of knee joint effusion by ultrasound (P＜0.05) in 95 RA patients were significantly decreased compared to those before operation.ESR [27(12,54)mm/1h vs.20 (16,28) mm/1 h,P＜0.001],CRP [3.27(1.06,6.95) mg/L vs.1.41(0.34,3.03)mg/L,P＜0.001],knee discomfort score [2(0,5) vs.1(0,3),P＜0.05],back pain visual analogue score (VAS) [5(4,5) vs.2(1,3),P＜0.001],and the volume of knee joint effusion by ultrasound (P＜0.001) in 58 SpA patients were significantly lower than those before the operation.The rate [16.84％(16/95) vs.6.32％(6/95),P=0.023] and grading (P=0.007) of popliteal cyst in RA were decreased after the operation.No statistically difference was observed in the rate [6.90％ (4/58) vs.5.17％(3/58),P=0.697] of popliteal cyst in patients with SpA,yet with a trend of decrease in 4 patients.Conclusion This study provide evidence that knee arthroscopic synovectomy has a good effect for refractory knee arthritis,which can reduce disease activity,improve joint symptoms and decrease the grading of popliteal cyst.

Clinical and Radiological Evaluation After Chemical Synovectomy With Rifampicin in Hemophilic Arthropathy: Korean Experience With a 2-Week Interval Protocol

OBJECTIVE: To assess the clinical outcome of chemical synovectomy with rifampicin in hemophilic arthropathy by using the World Federation of Hemophilia (WFH) scoring system and plain radiograph. METHODS: We performed rifampicin synovectomy (RS) on 30 joints of 28 hemophilic patients diagnosed as hemophilic arthropathy stage I–III (based on Fernandez-Palazzi clinical classification). Clinical status (bleeding frequency, pain, joint physical status) and radiological staging were evaluated as parts of the WFH scoring system before and 1 year after RS. The patients were divided into two groups by the Arnold-Hilgartner scale of the initial X-ray as stage 3 or less for the low-stage group (n=17) and over 3 for the high-stage group (n=13). RESULTS: Total WFH joint physical scores were reduced after injection, and the number of bleeding episodes and pain showed especially significant improvement. For other subscores of the WFH joint physical score, only swelling, range of motion, and crepitus showed statistically significant improvement. According to the severity of the radiologic finding, the WFH joint physical score of both the low-stage and high-stage groups showed significant improvement. In the radiological aspect, the low-stage group, without joint space narrowing at the initial plain radiograph, showed no further aggravation after injection. However, in the high-stage group, radiology found aggravation regardless of the procedure. CONCLUSION: It is suggested that chemical synovectomy with rifampicin may prevent hemarthrosis and improve clinical symptoms. Especially in the early stage of arthropathy without joint-space narrowing, it seems to have an additional benefit that delays radiological aggravation and preserves joint status.

Arthroscopic synovectomy for the treatment of stage II to IV trapeziometacarpal joint arthritis / Journal of Rural Medicine

Objective: As a minimal invasive surgery for the treatment of thumb carpometacarpal joint (trapeziometacarpal [TMC]) arthritis, we performed an arthroscopic synovectomy for Eaton stage II to IV arthritis.Patients and Methods: We included patients who were effectively treated with a corticosteroid injection, experienced recurrence of TMC pain, and had no major instability of the TMC. Surgery was performed in 17 female patients. Synovectomy was performed, when possible, using radiofrequency and a shaver. The mean follow-up period was 27.2 months.Results: Two patients required additional surgery; however, 15 patients were satisfied with the outcome. The mean visual analogue scale score improved from 8.8 preoperatively to 2.2 postoperatively.Conclusion: Arthroscopic synovectomy is indicated to be an effective treatment for stage II to IV TMC arthritis. The goal of this treatment was to relieve severe pain minimally invasively. Furthermore, if symptoms remain or reoccur, another curative procedure can be chosen.

Clinical outcomes of total hip arthroplasty for treatment of end-stage hip joint with pigmented villonodular synovitis / 局解手术学杂志

Objective To study the clinical efficacy of total hip arthroplasty for treatment of end-stage hip with pigmented villonodular synovitis(PVNS).Methods From January 2000 to March 2015,a total of 34 patients with hip PVNS were treated by total hip arthroplasty (THA) combined with synovectomy.Pelvic X-ray,CT and MRI examinations were performed before the surgery,and Harris hip joint function score was performed before and after surgery.Systematic rehabilitation training was performed after the operation,and the hip joint X-ray films were regularly reviewed.Results All the 34 patients were reviewed and observed for an average of 5.2 years (ranged from 1.5 to 7 years).The position of the prosthesis was good and the motion of the joint was satisfactory.The mean preoperative Harris hip scores improved from (45.0 ± 6.4) perioperatively to (90.2 ± 3.2) postoperatively,with statistically significant difference (t =0.468,P ＜ 0.05).None of the patients had clinical or radiographic evidence of recurrent PVNS.Conclusion Total hip arthroplasty combined with synovectomy is an effective therapeutic choice for end-stage hip with pigmented villonodular synovitis,which can improve the clinical results and prevent the disease recurrence.

Potential Adjunctive Role of Radiosynovectomy in Primary Synovial Osteochondromatosis of the Knee: A Case Report / 대한핵의학회잡지

Primary synovial osteochondromatosis (PSOC) is a rare but clinically significant cause of morbidity especially in the male population. Surgery is the primary treatment of choice, but the recurrence rate is reported to be high. Moreover, the presence of widespread loose bodies makes it a cumbersome procedure. The complete removal of the disease is tough at times and results in early recurrence. Radiosynovectomy is an established technique for treating various joint arthropathies. The role of radiosynovectomy in case of PSOC has not yet been explored. This case report described the case of a young male with PSOC of the knee joint who was treated with radiosynovectomy for pain relief. The patient reported complete relief from the pain along with significant improvement in joint mobility. The post-therapy three-phase bone scan also validated the reduction in joint inflammation. The patient was taken for surgical removal of the redundant loose bodies after a significant improvement in the pain and reduction in inflammation. Post-therapy radiation fibrosis of the synovium also helped in the en bloc removal of the disease. The role of radiosynovectomy in PSOC needs to be further explored concerning its potential role as an adjuvant to surgical procedures.

Long-Term Efficacy of Rehabilitation Following Arthroscopic Synovectomy in Patients With Rheumatoid Arthritis Treated With Biologic Agents

OBJECTIVE: To investigate the long-term efficacy of rehabilitation following arthroscopic synovectomy in patients with rheumatoid arthritis treated with biologic agents. METHODS: Arthroscopic synovectomy was performed in 29 joints of 17 patients, which were divided into two groups. Group 1 included arthroscopic synovectomy plus rehabilitation for 19 joints in 10 patients, and group 2 included arthroscopic synovectomy without rehabilitation for 10 joints in 7 patients. The Disease Activity Score C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Independence Measure (FIM) values (motor subscale) at 9.7 years after arthroscopic synovectomy were evaluated to identify the clinical factors related to outcomes. RESULTS: The increase in FIM score was significant in group 1 (p=0.05). HAQ-DI at 9 years was significantly decreased in group 1 (p=0.02). Therefore, arthroscopic synovectomy with rehabilitation was significant in improving FIM and HAQ-DI scores over a long period. Multiple regression analysis of FIM scores at 9 years indicated that rehabilitation (p=0.03) and disease duration (p=0.02) were significantly related to outcomes. FIM score at 9 years was significantly negatively correlated with disease duration (p=0.01, r=−0.58, Y=88.89–0.21X). CONCLUSION: Rehabilitation following arthroscopic synovectomy was effective in achieving high FIM scores over time in patients with rheumatoid arthritis.

Diffuse-Type Giant Cell Tumor Arising from a Pretibial Lesion: Extra-Articular Pigmented Villonodular Tenosynovitis / 대한정형외과학회잡지

Pigmented villonodular synovitis (PVNS) is a rare, benign, soft tissue neoplasm affecting the synovium of joints, classified as localized and diffused type. Localized type is more common, arising from synovium of joints, bursae, and tendon sheaths. Diffused type is relatively rare, frequently arising from an extra-articular lesion, and sometimes from an intramuscular or subcutaneous lesion. Although the cause of occurrence is not yet clear, recently it has been known as a benign neoplasm rather than an inflammatory or reactive process. We performed a total excision of the PVNS in a pretibial lesion and achieved a good result. We report on the case with a review of the literature.

The diagnostic value of the early rheumatoid arthritis classification criteria and clinical efficacy of knee arthroscopic synovectomy for early RA / 中国基层医药

Objective To evaluate the diagnostic value of the early rheumatoid arthritis (RA) classification criteria for early RA and to assess the clinical efficacy of knee arthroscopic synovectomy for RA.Methods A total of 62 patients who had arthritic complaints with disease duration less than one year were treated with knee arthroscopic synovectomy.Patients were diagnosed as RA confirmed by changes of synoviomorphous under arthroscopy,synovial biopsy,immunological biochemical laboratory and MRI,and compared with the preoperative ERA diagnosis.The efficacy was assessed at the third months and more than 12 months after operation,including Health Assessment Questionnaire (HAQ),Lysholm score,laboratory parameters of erythrocyte sedi-mentation rate (ESR) and C-reactive protein (CRP).Results The sensitivity and specificity in the early RA classification criteria for RA diagnosis were 81.58％ and 91.67％.38 patients diagnosed as RA and the remaining 24 patients were significantly improved of HAQ,Lysholm score,ESR,CRP compared with preoperation,showed statistical difference (P ＜ 0.01).There were still statistical differences between the follow-up results of the group of patients with RA in different period after operation (P ＜ 0.01).Conclusion The early RA classification criteria is worthy of clinical application,because it has the advantages of simple,practical,and is beneficial to early diagnosis of RA.The early RA patients should be treated with knee arthroscopic synovectomy as far as possible.It can improve not only the knee function,but also the general symptoms,and it can interrupt the RA pathological process,effective maintain curative effect after operation.

Pigmented Villonodular Synovitis in Forefoot (A Case Report) / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) is a slowly, progressive, proliferative disorder of synovial tissue characterized by villous or nodular changes of synovial-lined joints, bursae, and tendon sheaths and most frequently affects the large joints, with the knee and hip. A few studies have been reported that occurred PVNS in small joint, but mainly in hands. It is a very rare condition that occurs in the small joints of the forefoot. We have experienced the case, which developed in small joint of the forefoot, and performed total synovectomy. After the operation, there was no recurrence. We report a case of PVNS in forefoot with a review of the literature.

Cryptococcal Tenosynovitis of the Hand in a Patient with Rheumatiod Arthritis: A Case Report

Cryptococcosis is a fungal infection caused by Cryptococcus neoformans which is frequently occurred in the immunosuppressed host. Any organ or tissue may become infected, however, tendon sheath infection is extremely rare. We report a case of primary cryptococcal tenosynovitis after direct skin injury in a patient with rheumatoid arthritis who has been treated with methotrexate and leflunomide.

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.

Outcomes of Diffuse-Type Pigmented Villonodular Synovitis (PVNS) after Open Total Synovectomy / 대한골관절종양학회지

PURPOSE: Pigmented villonodular synovitis (PVNS) is a rare soft tissue tumor, which usually arises in larger joints, such as the knee. It has a high recurrence rate after surgical treatment. The purpose of this study is to evaluate and analyze the clinical results of diffuse-type pigmented villonodular synovitis cases that were treated with open total synovectomy. MATERIALS AND METHODS: Between 1994 and 2006, 21 patients who had diffuse-type pigmented villonodular synovitis were selectively reviewed. Among the 21 cases studied, 14 patients presented at the knee, 5 at the ankle, and 2 at the shoulder and elbow. The mean follow up period was 5.5 years (range, 36-157 months). The average age of the patients was 34 years consist of 7 men and 14 women. Clinical outcomes were analyzed retrospectively, including range of motion and complications. RESULTS: Open total synovectomy and adjuvant electrocautrization were done in all cases except one. During the regular follow-up period after the surgery, two patients showed symptoms of recurrence. After re-operation, only one case was pathologically confirmed as a recurrence. The patient who had partial synovectomy and the other patient who had second operation due to recur rence received additional radiation therapy. Clinical outcome scores were improved in every aspect (p<0.0001). 2 out of 14 Patients who had pigmented villonodular synovitis at the knee developed stiff knee after the surgery. CONCLUSION: After the open total synovectomy with electrocautrization, a low recurrence rate and satisfactory clinical outcome was achieved, observed in a minimum of 3 years of follow-up.

Effectiveness of radiation synovectomy with samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients with knee synovitis: a controlled randomized double-blind trial

OBJECTIVES: The aim of the present study was to investigate the effectiveness of Samarium153-particulate hydroxyapatite radiation synovectomy in rheumatoid arthritis patients with chronic knee synovitis. METHODS: Fifty-eight rheumatoid arthritis patients (60 knees) with chronic knee synovitis participated in a controlled double-blinded trial. Patients were randomized to receive either an intra-articular injection with 40 mg triamcinolone hexacetonide alone (TH group) or 40 mg triamcinolone hexacetonide combined with 15 mCi Samarium153-particulate hydroxyapatite (Sm/TH group). Blinded examination at baseline (T0) and at 1 (T1), 4 (T4), 12 (T12), 32 (T32), and 48 (T48) weeks post-intervention were performed on all patients and included a visual analog scale for joint pain and swelling as well as data on morning stiffness, flexion, extension, knee circumference, Likert scale of improvement, percentage of improvement, SF-36 generic quality of life questionnaire, Stanford Health Assessment Questionnaire (HAQ), Lequesne index, use of non-steroidal anti-inflammatory drugs or oral corticosteroids, events and adverse effects, calls to the physician, and hospital visits. RESULTS: The sample was homogeneous at baseline, and there were no withdrawals. Improvement was observed in both groups in relation to T0, but no statistically significant differences between groups were observed regarding all variables at the time points studied. The Sm/TH group exhibited more adverse effects at T1 (p<0.05), but these were mild and transitory. No severe adverse effects were reported during follow-up. CONCLUSION: Intra-articular injection of Samarium153-particulate hydroxyapatite (15 mCi) with 40 mg of triamcinolone hexacetonide is not superior to triamcinolone hexacetonide alone for the treatment of knee synovitis in patients with rheumatoid arthritis at 1 y of follow-up.

Results of Open Synovectomy for Rheumatoid Elbow

PURPOSE: To identify the recovery of joint movement and decrease in pain through the radiological findings after open synovectomy for the elbow with rheumatoid arthritis which was not cured by medication. MATERIALS AND METHODS: From 1997 to 2008, the research on open synovectomy for the elbow with rheumatoid arthritis was done in 19 patients with 21 cases whose average follow-up was 12 months. Despite the medical treatment, the indication of operation was towards the patients with Larsen grade I~III rheumatoid arthritis whose joint swelling and pain had not been improved. Also, the indication of operation included the patients with Larsen grade IV who rejected joint replacement or needed to postpone the operation due to young age. Main symptom was pain in all cases; Preoperative flexion contracture and flexion-extension movement on average was 29 degree and 86 degree, respectively.Postoperative radiological and physical examination were done; Visual analogue scale and Mayo elbow performance score were measured. RESULTS: Joint swelling recurred in two cases (9.5%). However, the size of swelling was mild compared to preoperative condition. Preoperative total mean flexion contracture was 29 degree (10~45 degree) and total mean flexion-extension movement was 86 degree (60~135degree). Last follow-up total mean flexion contracture was 18 degree (5~50 degree) and total mean flexion movement was 102 degree (35~150 degree). Statistically, the increase of range of joint movement was not significant. Radiologically, there were 11 cases(52.3%) showing no changes in preoperative and postoperative grade while there were 10 cases(47.6%) with increase in grade. As for VAS score, total mean preoperative score was 5 and postoperative score was 2.3(0~8) showing less pain than the past. After statistical analysis separated by Grade I, II, III and IV, last follow-up of VAS score, Mayo elbow performance score and elbow joint movement showed no statistical difference compared to Larsen grade (p=0.075). CONCLUSIONS: Open Synovectomy for elbow with rheumatoid arthritis can not stop radiological progress, and the increase in range of joint movement is not statistically meaningful. However the operation displays clinical improvement such as decrease in pain and increase in range of joint movement.

Synovial Chondromatosis of the Ankle Joint / 대한족부족관절학회지

PURPOSE: We evaluated the results of treatment and clinical symptoms of 11 cases of synovial chondromatosis in the ankle joint. Material and Method: From February 2001 to May 2008, 11 cases with synovial chondromatosis involving ankle joint underwent surgical treatment. There were 5 males and 6 females. The average age at surgery was 51 years. The average follow-up period was 42 months. Duration from onset of symptom to treatment was 117 months. Chief complaints of patients, 9 cases were pain and 1 case was mass like lesion, 1 case was found on x-ray. Preoperatively, all cases were evaluated on simple x-ray, 4 cases on CT, 4 cases on MRI and 1 case on ultrasonogram. 10 cases underwent synovectomy and loose body removal. 5 cases of 10 cases underwent open synovectomy and loose body removal and arthrosocpic surgery. 4 cases of 10 cases underwent only open synovectomy and loose body removal and 1 case of 10 cases underwent only arthroscopic surgery. 1 case underwent tibiotalar arthrodesis. RESULTS:The location of loose bodies was 7 cases on posterior and 4 cases on anterior and 4 case on lateral and 3 cases on multiple site. Postoperatively, all patients showed marked clinical improvement and had subjective satisfaction except reoperation 2 cases and arthrodesis 1 case. AOFAS score of all patients was average 82.2. CONCLUSION: Clinical results of the synovial chondromatosis of ankle joint were satisfactory. More accurate preoperative evaluation is required to achieve prevention of postoperative recurrence and better outcome.

Posterior Tibialis Tendon Dysfunction: Preliminary Report / 대한정형외과학회잡지

PURPOSE: Posterior tibialis tendon dysfunction (PTTD) is one of the most common causes of acquired flatfoot deformity in western countries. But it was known that they were very rare in eastern countries. So we want to report the clinical features and outcomes of 12 patients with PTTD. MATERIALS AND METHODS: We evaluated the results of 12 patients using clinical features and results from March 2000 to January 2007 and mean follow up periods is 32 months. RESULTS: Average age was 45 years, 8 of 12 patients were female, 2 patient with hypertension and 1 with rheumatoid arthritis. 5 patients were overweighted and 5 patients were obese. 4 patients has a history of last trauma. 4 patients experienced progression of flatfoot. On behalf of Johnson and Strom classifications 6 cases were grade I, 4 cases were grade II, grade III, and grade IV was 1 case, relatively. As a treatment we used tenosynovectomy for 3 cases of grade I, additional FDL transfer was done for 2 cases of grade I and 2 cases of grade II. For other 2 patients of grade II flexor digitorum longus transfer and Medial displacement calcaneal osteotomy was done. Pathologic findings of tendon showed degenerative tendinitis. Lastly conservative treatment group was 3 cases of grade I, III, IV each. Average preoperative and postoperative American Orthopedic Foot and Ankle Society's hindfoot/ankle scoreFAS score was 58 and 90. Initial and follow up AOFAS scores of the conservative group was 38 and 57, relatively. CONCLUSION: As a cause of acquired flatfoot in adult, PTTD is not a rare disease any more in Korea. To prevent the disability and progression of flatfoot, careful clinical evaluation and proper treatment is important.

Arthroscopic Synovectomy in a Patient with Primary Hypertrophic Osteoarthropathy / 대한류마티스학회지

No abstract available.