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A 34-year-old woman presented with paroxysmal, insidious shoulder pain with effusion. MRI demonstrated a permeative, intermediate-signal lesion on T1 and T2 sequences involving the glenohumeral joint and biceps tendon sheath. The patient was treated with arthroscopic synovectomy, debridement, and subpectoral biceps tenodesis, with histopathology demonstrating pigmented villonodular synovitis (PVNS). PVNS is an extremely rare lesion of the glenohumeral joint and surrounding extra-articular structures. Awareness of this condition is paramount for timely diagnosis and intervention before joint destruction occurs. Arthroscopic treatment with meticulous attention to surgical technique is a feasible treatment strategy in the absence of end-stage chondral damage.

Knee arthroscopy has evolved greatly from its inception in the twentieth century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We continue to develop more minimally invasive procedures and the Nanoscope (Arthrex, Naples, FL) has provided a new generation of possibilities. The system does not require the use of a standard incision or portal and with the use of the Graftnet (Arthrex, Naples, FL) we can harvest tissue with a standard shaver for further evaluation. This technique provides an option to perform a synovectomy and biopsy without the use of a standard arthroscopy portals through an incisionless approach.

Inflammatory arthritis of elbow at the outset may present with pain, swelling, and restriction of movements, while deformities are associated with chronic cases. Surgical intervention is the mainstay of treatment, especially in rheumatoid elbow not responding to conservative management and disease-modifying anti-rheumatoid drug (DMARD) therapy. Traditionally, open procedures along with radial head resection were the most popular procedures and associated with severe morbidities as elbow joints are very notorious for being stiff after any manipulation or surgical intervention. With the advent of new techniques, equipment, and surgical skills, it is convenient to perform synovectomy, debridement, and decompression of elbow joint with keyhole arthroscopic surgeries, which are becoming very popular to improve arc of motion and pain relief with minimal postoperative morbidity as it allows early rehabilitation. Recent literature has documented effectiveness of arthroscopic synovectomy in inflammatory arthritis (mild-to-moderate severity) of elbow at short-term as well as long-term follow-up. Arthroscopic surgery of elbow is more demanding than open procedures so a steep learning curve may be expected for surgeons.

Pigmented villonodular synovitis (PVNS) is a relatively rare, benign lesion characterized by exuberant proliferation of the synovial tissue that most commonly affects the knee and hip joint. Magnetic resonance imaging (MRI) is the imaging modality of choice for the diagnosis of PVNS. The disease is confirmed histologically by examination of the synovial tissue removed. The mainstay of treatment is synovectomy, performed in an open, arthroscopic, or combined fashion. Although postoperative adjuvant external beam radiotherapy can improve the local recurrence rate, the course of the disease is not always uneventful. We present a rare case of a 10-year-old boy presented to our orthopaedic department with a four-month history of intermittent right knee pain and swelling. MRI revealed joint effusion and extensive nodular synovial proliferation suggestive of PVNS. An arthroscopic synovectomy was performed and histological examination confirmed the diagnosis. The postoperative course was uneventful. Clinical suspicion of PVNS is essential in children with chronic knee pain and swelling. Arthroscopic synovectomy is an effective and reliable treatment option.

Pigmented villonodular synovitis is a rare condition in the adolescent population affecting synovial joints. The knee joint is affected primarily with the diffuse form. The localized form is less commonly encountered. Open and arthroscopic synovectomy lead to similar outcomes and resolution of symptoms. However, recurrence is higher with open procedures. We present a review of the literature examining outcomes of arthroscopic synovectomy.

Die Handchirurgie bei rheumatoider Arthritis hat sich nicht zuletzt aufgrund der Biologika und der Biosimilars erheblich verandert. Es wird der Stellenwert bewahrter und innovativer operativer Verfahren in der modernen Therapie der Rheumahand herausgearbeitet. Auserdem erfolgt eine Einordnung lokaler Interventionsmoglichkeiten in diesen Kontext. Es erfolgen eine Auswertung, Bewertung und Diskussion von Literatur und Expertenempfehlungen. Bei konsequentem Einsatz der modernen Rheumamedikamente laufen die Destruktion und Deformation des Handgelenks und der Hand langsamer und weniger schwer ab. Der Handchirurg kann deswegen gezielter, auf weniger Einzelpathologien fokussiert operieren. Bis heute haben dabei viele der von den Pionieren der modernen Handchirurgie beschriebenen Techniken weiterhin ihre Berechtigung. Ein groser Teil der Uberlegungen zur Korrektur der gestorten Biomechanik und zur Wiederherstellung von Stabilitat und Beweglichkeit hat unverandert Gultigkeit. Die Kombination von arthroskopischer Synovialektomie und Radiosynoviorthese am Handgelenk scheint vielversprechend zu sein. Die moderne Therapie der Rheumahand ist eine multidisziplinare Herausforderung. Rheumatologe, Nuklearmediziner und Handchirurg konnen gemeinsam viel erreichen. Eine konsequente medikamentose Therapie, im Bedarfsfall ein fruhzeitiges operatives Eingreifen und eine systematische Einbindung des Nuklearmediziners in die Therapiekonzepte ermoglichen es, langfristig die Funktion der Hand als unser „Hauptwerkzeug“ im Alltag zu erhalten.

Introduction: Arthropathy is the typical lesion of hemophilia, mainly occurring in the elbows, knees and ankles, and it is due to repetitive hemarthrosis secondary to the absence of any of the normal coagulation factors (factor VIII in hemophilia A, factor IX in hemophilia B).Areas covered: In this article, the current forms of prevention and management of joint problems in hemophilia (joint aspiration, radiosynovectomy, arthroscopic synovectomy, joint debridement, arthrodesis, and total joint prostheses) are reviewed. Besides prophylactic treatment with coagulation concentrate there are other tools that could detect and help to prevent joint status and function very early (ultrasonography, infrared thermography, gate analysis, surface electromyography). Early comprehensive evaluations of the musculoskeletal system should be made so that individualized physical therapy and sports therapy programs can be developed.Expert opinion: Primary hematological prophylaxis (intravenous infusion of the defici...

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.

ZusammenfassungZur arthroskopischen Synovialektomie der Metacarpophalangealgelenke (MCP-Gelenke) sind bisher kaum Arbeiten erschienen. Sie berichten jedoch über vielversprechende Ergebnisse. Ziel der vorliegenden Arbeit ist die Auswertung der subjektiven Ergebnisse nach arthroskopischer Synovialektomie bei Patienten mit rheumatoider Arthritis. Von 2009 bis 2013 wurden 137 arthroskopische Synovialektomien der MCP- und der proximalen Interphalangealgelenke (PIP) bei 77 Patienten mit rheumatoider Arthritis durchgeführt. Nach Berücksichtigung der Ausschlusskriterien verblieben 41 Patienten, bei denen ein oder mehrere MCP-Gelenke oder zusätzlich ein PIP-Gelenk behandelt wurden. Telefonisch konnten 39 Patienten mit 76 MCP-Gelenken nach durchschnittlich 22,7 (9–42) Monaten retrospektiv zu Schmerzreduktion, Funktionsverbesserung und Zufriedenheit mit dem Eingriff befragt werden. 37 Patienten mit 74 operierten Gelenken waren mit dem Eingriff zufrieden und würden ihn erneut durchführen lassen. Die Verringerung des Ruhe- und Bewegungsschmerzes war signifikant, ohne dass hierbei ein Zusammenhang mit dem präoperativen Röntgenstadium festzustellen war. Intraoperativ konnte in allen Fällen eine Synovialitis bestätigt werden. Die Ergebnisse der vorgelegten Arbeit zeigen, dass mit der arthroskopischen Synovialektomie der MCP-Gelenke bei rheumatoider Arthritis eine hohe Patientenzufriedenheit erreicht werden kann. Voraussetzung für die Indikation ist ein intakter Bandapparat der MCP-Gelenke ohne biomechanische Veränderungen.

Introduction: Synovial hemangioma is a rare condition with

Introduction: Lipoma arborescens is a rare lesion, benign in nature and was first described in detail in 1957.

Background Baker’s cyst or popliteal cyst is the most common mass surrounding the knee joint that results from inflammatory knee arthritis. With increasing number of arthroscopic synovectomy performed for refractory knee arthritis annually, we aim to explore its value in baker’s cyst treatment.[1] Objectives To investigate the efficacy of arthroscopic synovectomy on refractory knee arthritis complicated with popliteal cyst. Methods A retrospective analysis of 153 patients (RA= 95, SpA= 58) with refractory knee arthritis, underwent knee arthroscopic synovectomy in our hospital from 2010 to 2017, was performed. Among them, 20 patients (RA= 16, SpA= 4) complicated with popliteal cyst. We compared the changes in inflammation makers, disease activity score, imaging manifestations, symptoms, the rate and the grading of popliteal cyst[2] before and after the operation to evaluate the efficacy of knee arthroscopic synovectomy.[3] Results: inflammation markers[ESR(49.42±32.54 vs 24.46±24.17, P 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. References [1] Zhou X N, Li B, Wang J S, et al. Surgical treatment of popliteal cyst: a systematic review and meta-analysis[J]. Journal of Orthopaedic Surgery & Research, 2016, 11(1):22. [2] Rauschning W, Lindgren P G. Popliteal cysts (Baker’s cysts) in adults. I. Clinical and roentgenological results of operative excision.[J]. Acta Orthop Scand, 1979, 50(5):583-91. [3] [3]Rupp S, Seil R, Jochum P, et al. Popliteal cysts in adults. Prevalence, associated intraarticular lesions, and results after arthroscopic treatment[J]. Am J Sports Med, 2002, 30(30):112-115. Disclosure of Interests None declared

Surgical interventions usually needed for hemophilic arthropathy include arthroscopic synovectomy, alignment osteotomy, arthroscopic joint debridement, radial head removal, arthrodesis of the ankle, and total joint arthroplasty (elbow, hip, knee, ankle). Areas covered: Whatever the surgical technique, appropriate surgical hemostasis must be achieved through infusion of concentrate of the deficient factor (factor VIII or factor IX), either in recombinant or plasma-derived form, at the correct dosage (ideally for 10-14 days). In patients with inhibitors, there are also the aPCCs (activated prothrombin complex concentrates) and rFVIIa (recombinant activated FVII). These surgical procedures are safe even in the most complex cases such as patients with inhibitors or who are human immunodeficiency virus-positive (HIV+) and hepatitis C virus-positive (HCV+). Expert opinion: The risk of bleeding in surgical procedures is higher for hemophilic patients than for other patients and there is also a greater risk of infection. Both these factors increase the risk of a poor outcome. Orthopedic surgery in hemophilia improves the patient's quality of life.

Subacromial impingement syndrome (SIS) is the leading cause of shoulder pain. A systemic approach for abnormal causes of SIS is recommended to avoid misdiagnosing rare or sinister pathologies. To our knowledge, only nine cases of subacromial lipoma arborescens associated with impingement syndrome have been reported in the literature. In this report, we briefly discuss histopathologic and radiological signs of an unusual case of impingement syndrome caused by subacromial “lipoma arborescens” and describe arthroscopic synovectomy after the failure of conservative management. The patient remains symptom-free five years after surgery.

Hintergrund: Zur operativen Behandlung der Chondrokalzinose (Kalziumpyrophosphat-Dihydrat-Arthropathie=CPPD-Erkrankung) am Handgelenk gibt es kaum Angaben. Da die chronisch rezidivierenden Verlaufe der CPPD-Erkrankung zwischen denen der rheumatoiden Arthritis (RA) und der Arthrose angesiedelt sind, hat die Autorin die arthroskopische Synovialektomie angewendet, die bei der RA etabliert ist und dort als atraumatisches Verfahren mit niedriger Morbiditat sehr gute Ergebnisse erzielt und einen hohen Patientenkomfort bietet. Die vorliegende Arbeit stellt die Erfahrungen mit der arthroskopischen Synovialektomie des Handgelenks bei Chondrokalzinose vor. Patienten und Methoden: Von 74 arthroskopischen Synovialektomien bei 71 Patienten mit symptomatischer CPPD-Erkrankung des Handgelenks konnten 46 Eingriffe bei 43 Patienten durchschnittlich 26,6 Monate postoperativ ausgewertet werden. Die 15 Frauen und 28 Manner im Alter von 64,5 (42–90) Jahren wurden telefonisch nach Schmerzen, Funktionseinschrankung und ihrer Zufriedenheit befragt. Die intraoperativen und die histologischen Befunde wurden erfasst. Entsprechend der Klassifikation nach Romano lag praoperativ 6-mal ein SCAC (Scaphoid Chondrocalcinosis Advanced Collapse) I (13%), 18-mal SCAC II (39%), 9-mal SCAC III (19,5%) und 3-mal ein SCAC IV (6,5%) vor. 10 Rontgenbilder konnten nicht nach Romano klassifiziert werden. Ergebnisse: Die Schmerzreduktion in Ruhe und bei Belastung und die Funktionsverbesserung waren signifikant. 74% der Patienten wurden sich erneut dem Eingriff unterziehen. Arthroskopisch zeigte sich in allen Fallen das typische Bild der CPPD-Ablagerung. Bei 38 der 46 Operationen wurde eine histologische Untersuchung durchgefuhrt, die in 20 Fallen positiv war. Schlussfolgerung: Die arthroskopische Synovialektomie des Handgelenks fuhrt unabhangig vom radiologischen Stadium zu einer hohen Patientenzufriedenheit. Das Verfahren ist atraumatisch und zeichnet sich durch geringe Morbiditat und hohen Patientenkomfort aus. Es wird vorgeschlagen die Klassifikation nach Romano um ein fruhes Stadium SCAC 0 zu erweitern. Moglicherweise ist die CPPD haufiger als vermutet Ursache von unklaren Handgelenksbeschwerden auch schon in mittlerem Lebensalter.

Lipoma arborescens is an intra-articular benign tumor characterized by villous synovial hypertrophy that can cause chronic joint pain and effusions. This disease is rare in adults and exceptionally rare in children. We present the case of an otherwise healthy 10-year-old boy who presented with a painful chronic left knee effusion. The workup included radiographs, MRI, and laboratory analysis, and he was diagnosed with lipoma arborescens. He underwent arthroscopic synovectomy and had a full recovery with the ability to return to all desired activities.

Radiosynovectomy (RS) is a simple, effective and safe procedure for the control of haemophilic synovitis that causes repetitive haemarthrosis. It must be done after confirming clinically (hard and painless mass on palpation) and by ultrasonography the existence of synovitis in a joint with recurrent haemarthrosis. RS should be the first invasive option (instead of arthroscopic synovectomy) for treatment of chronic synovitis. The technique is highly cost effective in comparison to arthroscopic synovectomy. The indication for RS is the presence of repeated haemarthroses associated with synovitis (confirmed clinically and by imaging techniques) that cannot be controlled by means of haematological treatment. No increase in the risk of cancer has been published and the dose of radiation utilized in RS is minimal. In haemophilic patients with recurrent haemarthrosis, RS should be performed under factor coverage as soon as possible, once the existence of synovitis has been confirmed by ultrasonography. RS should really be considered as a useful adjunctive procedure to the primary intervention, which is intensive replacement therapy.

The aim of the present study was to assess the clinical outcomes of arthroscopic synovectomy in adolescent or young adult patients with advanced haemophilic arthropathy. From January 2009-January 2012, clinical data from 11 adolescent or young adult patients with advanced haemophilic arthropathy who were treated with arthroscopic synovectomy were retrospectively collected. The mean follow-up period was 71.91±5.28 months. The evaluated indicators included frequency of joint bleeding, range of motion (ROM), X-ray staging, hospital for special surgery (HSS) knee score and HSS pain scores. Joint bleeding frequency, pain degree and HSS scores significantly improved following arthroscopic synovectomy at the end of the follow up period. The ROM did not significantly improve. Among the 11 patients, radiographic stage remained unchanged in 9 cases whereas the remaining 2 cases progressed from stage IV to stage V. No patients required total knee arthroplasty through the end of the follow-up period. These findings suggested that arthroscopic synovectomy appears to an effective treatment option to decrease the frequency of bleeding and knee pain, improve knee function and delay knee joint arthroplasty to a certain extent for adolescent or young adult patients with advanced haemophilic knee arthropathy.

Synovitis of the interphalangeal joint of the great toe can occur in patients with rheumatoid arthritis, seronegative arthritides, or gouty arthritis or after a penetrating injury to the joint. Complete synovectomy of the joint usually requires a lengthy incision and extensive soft-tissue dissection. The purpose of this Technical Note is to describe the surgical details of arthroscopic synovectomy of the hallucal interphalangeal joint, which can reduce the surgical trauma.

Rationale: Pachydermoperiostosis (PDP) is a rare hereditary disorder that affects the skin and bones. PDP is characterized by periostosis, digital clubbing, and pachydermia. Previous studies demonstrated that increased prostaglandin E2 (PGE2) levels resulting from defective protein degradation pathways play a crucial role in PDP pathogenesis, and males were more commonly and severely affected than females. Moreover, nearly all PDP patients suffer from refractory arthralgia. Although several different treatment modalities are used for PDP, therapy for this disease remains challenging. Patients concerns: Two cases of PDP showing symptoms consistent with polyarthritis and arthralgia that mainly affected the knees and ankles. Diagnoses: The diagnostic criteria for PDP include digital clubbing, periostosis, and pachydermia. The 2 patients were diagnosed as PDP based on the finger clubbing, facial cutis furrowing, knee and ankle arthritis, and radiographic evidence of periosteal proliferation. Interventions: Patient 1 had massive joint effusion that was treated by oral administration of etoricoxib and aescin combined with arthroscopic synovectomy, whereas Patient 2 had mild joint swelling and accepted only oral medication. Outcomes: Clinical symptoms of the 2 patients greatly improved after the treatment. During the 1-year follow-up, the patient experienced no adverse effects or recurrence. Lessons: The therapeutic results showed that oral etoricoxib could reduce inflammation and retard progression of pachydermia, or even relieve facial skin furrowing, but had limited efficacy for arthralgia. However, oral aescin had satisfactory efficacy for arthralgia. Thus, etoricoxib combined with aescin is a safe and effective treatment for PDP. Meanwhile, arthroscopic synovectomy can be used to treat joint effusion, but had no therapeutic effect on arthralgia. Therefore, postoperative oral medications would be needed as subsequent therapy for joint problems. In conclusion, this study proposes an effective and safe treatment plan to address symptoms experienced by PDP patients.

Introduction Pigmented villonodular synovitis (PVS) is a synovial proliferation disorder of uncertain aetiology, with some controversy as regards its proper treatment. The purpose of the study was to evaluate the functional outcome and recurrence rate in a series of patients diagnosed with both the diffuse and the localised types of PVS and treated by arthroscopic resection. Material and methods Twenty-four patients diagnosed with PVS were retrospectively assessed. There were 11 cases with the diffuse type, and 13 cases with the localised type of PVS. They were followed-up for a median of 60 months (range, 34–204). They underwent arthroscopic synovectomy, and were functionally evaluated with IKDC, WOMET, and Kujala scores. Results There was recurrence in 8 out of 13 (61.5%) cases with the diffuse type of PVS. Two of these patients were treated with radiation. One patient underwent surgical resection with an open procedure due to extra-articular involvement. The remaining 5 patients underwent a second arthroscopic resection, and no recurrence was subsequently observed. Cases with localised PVS did not recur after a single arthroscopic resection. IKDC, WOMET and Kujala scores improved by 30.6, 37.4 and 34.03 points, respectively. Discussion Pigmented villonodular synovitis treated by arthroscopic resection showed good functional results at mid-term follow-up. A single arthroscopic resection was sufficient to treat the localised PVS, whereas the diffuse type of PVS required a second arthroscopic resection in most cases, due to its high rate of recurrence.

Pigmented villonodular synovitis (PVNS) is a rare proliferative process of the synovium which most commonly affects the knee and occurs in either a localised (LPVNS) or a diffuse form (DPVNS). The effect of different methods of surgical synovectomy and adjuvant radiotherapy on the rate of recurrence is unclear. We conducted a systematic review and identified 35 observational studies in English which reported the use of surgical synovectomy to treat PVNS of the knee.A meta-analysis included 630 patients, 137 (21.8%) of whom had a recurrence after synovectomy. For patients with DPVNS, low-quality evidence found that the rate of recurrence was reduced by both open synovectomy (odds ration (OR) = 0.47; 95% CI 0.25 to 0.90; p = 0.024) and combined open and arthroscopic synovectomy (OR = 0.19, 95% CI = 0.06 to 0.58; p = 0.003) compared with arthroscopic surgery. Very low-quality evidence found that the rate of recurrence of DPVNS was reduced by peri-operative radiotherapy (OR = 0.31, 95% CI 0.14 to 0.70; p = 0.01). Very low-quality evidence suggested that the rate of recurrence of LPVNS was not related to the surgical approach.This meta-analysis suggests that open synovectomy or synovectomy combined with peri-operative radiotherapy for DPVNS is associated with a reduced rate of recurrence. Large long-term prospective multicentre observational studies, with a focus on both rate of recurrence and function, are required to confirm these findings.Cite this article: Bone Joint J 2015;97-B:550–7.

Open synovectomy remains the treatment of choice for pigmented villonodular synovitis (PVNS) of the hip but has shown modest results compared with the treatment of other joints. Recent advances in hip arthroscopy permit a thorough evaluation of the joint surfaces, improved access, and decreased postoperative morbidity. We describe an arthroscopic synovectomy technique for PVNS of the hip. The use of additional arthroscopic portals and creation of a large capsulotomy enable successful visualization and extensive synovectomy of the entire synovial lining of the hip. The T-capsulotomy enables extensive soft-tissue retraction for complete exposure. The midanterior portal enables use of an arthroscopic grasper and shaver to directly access and excise the synovial lining of the peripheral compartment while avoiding damage to the medial and lateral retinacular vessels. Technical innovations in hip arthroscopy have enhanced visualization in the central and peripheral compartments, as well as instrument management and diagnostic evaluation of the capsule, therefore allowing enhanced management of PVNS of the hip.

Case: We report a case of recurrent acute arthritis and restricted range of motion in the knee joint, with magnetic resonance imaging subsequently detecting a nodular lesion within the lateral meniscus. Knee arthroscopy and histology revealed that the lesion was intrameniscal gouty tophi. After arthroscopic synovectomy and excision of the tophi, the symptoms resolved and the patient remained symptom-free at two years of follow-up. Conclusion: Surgeons should be aware of the presence of such pathology and consider arthroscopic surgery if the mechanical symptoms persist.

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.

Pigmented villonodular synovitis (PVNS) is a benign aggressive disease that presents in either a localized (LPVNS) or diffuse (DPVNS) form. Arthroscopic synovectomy is the standard operative treatment for LPVNS, and when used to treat DPVNS, it is usually combined with an open posterior procedure. The purpose of this Technical Note is to report the technique that we have refined to allow for arthroscopic synovectomy as the sole treatment for DPVNS. We describe our technique with the factors we have found to be important to ensure adequate arthroscopic synovectomy, while minimizing risks and complications. The combination of additional portals, the use of multiple different shavers and arthroscopes, and the use of a leg holder all maximize our ability to clear disease.

» Hemophilia is among the commonest bleeding disorders encountered in orthopaedic practice and results from an Xchromosome-linked failure of coagulation factors VIII (hemophilia A) or IX (hemophilia B). » Morbidity in hemophilia is a result of repeated hemarthroses, and the aim of orthopaedic management is to prevent these, to treat them promptly, and to address the joint pathology that results. » Both radiosynovectomy and arthroscopic synovectomy are effective in reducing the degree of synovitis and the number of hemarthroses, although, to our knowledge, there is little evidence that it prevents progression to end-stage arthritis. There is substantial evidence for the safety and effectiveness of radiosynovectomy, and this is the first line of treatment in our practice. » In end-stage disease, total knee arthroplasty is challenging as a result of severe contractures and is associated with a higher rate of complications such as infection (7% compared with 1% to 2% in osteoarthritis) and need for blood transfusions and a higher revision rate than that seen in total knee arthroplasty for osteoarthritis. » However, many series of total knee arthroplasty for hemophilia have now been published, and excellent results can be gained in terms of pain relief and quality of life.

Synovial lipomatosis (SL; lipoma arborescens) is a tumor-like condition with villous proliferation of the synovium. The exact etiology of SL is still unknown. The knee is the most commonly involved part. The goal of this retrospective study was to report the results of arthroscopic synovectomy in patients with SL in their knee joints as well as to emphasize the importance of considering this pathology when treating patients with recurrent knee joint effusions. In total, 21 patients (8 females and 13 males) were evaluated retrospectively from May 2009 to July 2014. The mean follow-up period was 29.13 (range, 12–61) months. The mean duration of compliance was 22.76 (range, 7–61) months. All patients were evaluated by Knee Society score pre- and postoperatively. The mean preoperative and last follow-up Knee Society scores were 67.82 and 88.23 points, respectively. There was a significant difference between the preoperative and postoperative Knee Society scores (p = 0.0001). Histopathological examinations showed that the subsynovial layer exhibited diffuse replacement by mature fat cells that had formed villous projections. In addition, infiltration of mononuclear inflammatory cells was observed at different stages. SL is a nondestructive and benign tumor pathology of the knee joint without a clearly identified etiology. The main difficulty in diagnosis is lack of clinical practice.

Introduction: Hemophilia is characterized by recurrent bleeding episodes, most commonly in the knees, elbows and ankles. Repeated hemarthroses lead to synovial hypertrophy and a vicious cycle of chronic synovitis arises, leading to destruction of the joint. Areas covered: This article covers the pathogenesis of chronic hemophilic synovitis and its treatment by means of different types of synovectomy. Expert opinion: Both radiosynovectomy (RS) and arthroscopic synovectomy considerably improve the frequency of bleeding episodes. RS is the best option for patients with synovitis unresponsive to a three-month trial of hematological prophylaxis. If the bleeding is refractory to three successive episodes of RS at six monthly intervals, arthroscopic synovectomy is indicated. Open synovectomy should be reserved for adults with elbow synovitis requiring radial head removal and synovectomy in the same surgical session. RS is effective and safe, and particularly helpful in patients with inhibitors as they are at greatest risk of bleeding episodes and have the highest risk of complications of surgery.

Reports of osteomyelitis in the proximal humerus with pyogenic glenohumeral arthritis of adjacent joints mostly involve pediatric patients. Nowadays, osteomyelitis that is secondary to adjacent pyogenic glenohumeral arthritis is extremely rare, even more so in adults than in pediatrics. We report a rare case of the pyogenic glenohumeral arthritis followed by osteomyelitis of the proximal humerus in an elderly patient. Initially, we diagnosed a case of pyogenic glenohumeral arthritis only, which, despite arthroscopic synovectomy, did not resolve and severe pain continued. Subsequent radiological imaging, performed after our suspicion of a secondary involvement, allowed us to diagnose osteomyelitis combined with the pyogenic glenohumeral arthritis, which we had overlooked because of the extreme rarity of the condition in adults since the antibiotic era began.

Lipoma arborescens is a rare intra-articular condition of unknown exact aetiology. Lipoma arborescens is one of the differential diagnoses of diffuse chronic swelling of the knee and its magnetic resonance imaging (MRI) appearance is diagnostic. We present two cases of patients with recurrent knee effusion. MRI showed a frond-like fatty synovial mass and joint effusion that suggested the likelihood of lipoma arborescens. Arthroscopic synovectomy was performed and pathology confirmed the diagnosis. There was no recurrence of symptoms after synovectomy.

Objectives: A tenosynoival giant cell tumor known as pigmented villonodular synovitis (PVNS) is a rare, benign, yet locally aggressive neoplasm arising from the synovium. Although most frequently encountered in the knee joint, PVNS is secondly most commonly seen in the hip joint. Occurrence of PVNS in the hip may destroy intra-articular soft tissue and bone, and at times invade extra-articular tissues. There are two categorizations of PVNS: localized and diffuse. The localized manifestation, often referred to as nodular, involves a focal or limited area of the synovium, while the diffuse manifestation involves more widespread areas throughout the synovium. Surgical management by resection of the PVNS within the hip joint has been described with open procedures and arthroscopic procedures. Although surgical management has been shown to be promising, PVNS has a high recurrence rate, of 15-50%. To date, we present the largest cohort of hip joint PVNS managed by arthroscopic synovectomy with mid-term follow-up. Methods: A cohort of 19 patients were diagnosed with hip PVNS and underwent arthroscopic synovectomy between 2008 and 2016. Patients were identified preoperatively based on suspected MRI findings of PVNS or intraoperatively after unexpected PVNS was identified during arthroscopy for another pathology. We assessed patients’ functional ability at a minimum of 2-years follow-up using five patient reported outcome measures (PROMs): mHHS (modified Harris Hip Score), HOS (Hip Outcome Score), iHOT-33 (international Hip Outcome Tool), NAHS (Non-Arthritic Hip Score), and LEFS (Lower Extremity Functional Score). Results: Nineteen patients with hip PVNS were treated with an arthroscopic hip synovectomy. Sixteen of the patients completed patient reported outcome measures. This cohort consisted of 7 (44%) females and 9 (56%) males. The mean patient age was 37 years (range, 25-54). Mean follow-up was 83 months (6.9 years), ranging from 24 months (2 years) to 123 months (10.3 years). Eight (50%) patients had diffuse PVNS and 8 (50%) of patients had nodular PVNS. Laterality of the arthroscopic procedure was 8 (50%) right hip and 8 (50%) left hip. Five (31%) of the patients had a smoking history, while 11 (69%) were non-smokers. Four (25%) had a cam lesion, 4 (25%) had a pincer lesion, 8 (50%) had neither cam nor pincer lesion, and 0 (0%) had combined cam and pincer lesion. Fourteen (88%) patients had histologically confirmed PVNS. Eleven (69%) patients had MRI suspected PVNS prior to arthroscopy, while 5 (31%) patients had unexpected PVNS discovered intraoperatively. Concomitant pathology addressed at the time of arthroscopy, includes 11 (79%) labral tear repair. For the sixteen patients that completed patient reported outcome measures, the mean mHHS was 78.2 (SD, 10.6). Mean HOS-ADL was 10 (SD, 10). Mean HOS-SSS was 21 (SD, 20). Mean iHOT-33 was 69.4 (SD, 16.3). Mean NAHS was 86.5 (SD, 10.2). Mean LEFS was 70.8 (SD, 7.7). A mean percentage of maximal function was 88.6% (SD, 9.8%). To date, 0 (0%) patients have shown evidence of recurrence upon physical exam, follow-up MRI, or repeat arthroscopy. Conclusion: Based on the largest arthroscopically managed cohort of PVNS in the hip to date, we conclude that arthroscopic synovectomy is a reliable and effective treatment of hip PVNS. Patients reported good functional outcomes without evidence of recurrence in a 19 patient cohort with an average follow-up of almost 7 years.