1/39. foreign-body reaction to the bioabsorbable suretac device.SUMMARY: Arthroscopic shoulder stabilization with the bioabsorbable Suretac device (Acufex Microsurgical, Mansfield, MA) offers some technical advantages compared with other approaches. However, in 4 patients (3 men, 1 woman; between 20 and 35 years of age) with 3 SLAP lesions grades 2 and 1 post-traumatic anterior shoulder instability, breakage and early loosening of the Suretac device was observed. All patients complained about shoulder pain and loss of active and passive motion. The arthroscopic examination revealed a massive synovitis without positive cultures. Loose fragments of the Suretac device spread in the joint cavity and induced a foreign-body reaction. Histologically, there was a massive infiltration of phagocytic cells (histiocytes, multinucleated giant cells) and birefringent polymeric particles surrounded by or within histiocytes and multinucleated giant cells. All patients underwent arthroscopic synovectomy. Because of instability, 2 of them required restabilization, which was performed with suture anchors (Fastak [Arthrex, Naples, FL], Mitek [Mitek Division, Ethicon, Norderstedt, germany]). Postoperatively all patients were pain free, progressing to full active and passive range of motion. Our patients suffered from a mechanical failure rather than from a predisposition to exaggerated inflammatory response. According to this observation, the Suretac device seems to be prone to early failure in patients with SLAP lesions because of its biodegradability.- - - - - - - - - - ranking = 1keywords = joint (Clic here for more details about this article) |
2/39. Imaging of plant-thorn synovitis.We describe a case of plant-thorn synovitis of the elbow resulting from a thorn injury. This caused recurrent pain and swelling of the elbow over a 3-month period. A magnetic resonance imaging examination was initially requested to exclude septic arthritis, and demonstrated a joint effusion, synovitis, and a 2-cm linear opacity embedded in the synovium. Ultrasound was performed prior to surgery to confirm these findings and provide accurate localization of the thorn fragment, later removed at surgery. To our knowledge this is the first example of this condition that has been confirmed by radiological imaging prior to surgery.- - - - - - - - - - ranking = 1keywords = joint (Clic here for more details about this article) |
3/39. Aseptic synovitis after meniscal repair using the biodegradable meniscus arrow.We report a case of aseptic synovitis in a 19-year-old man. The synovitis of the left knee developed 13 months after meniscal repair using the biodegradable Meniscus Arrow (Bionx Inc, Malvern, PA). Histologic examination revealed chronic nonspecific synovitis and birefringent materials. Immunohistochemical tests were positive in lysozyme, alpha-1-antitrypsin, and alpha-1-antichymotrypsin. After arthroscopic synovectomy, pain and swelling of the knee joint were relieved and the patient's range of motion fully recovered. We have found no previous report of aseptic synovitis accompanying meniscal repair using the biodegradable Meniscus Arrow.- - - - - - - - - - ranking = 1keywords = joint (Clic here for more details about this article) |
4/39. Paratibial cyst associated with wear debris after total knee arthroplasty.We present a case in which a synovial cyst arose from the proximal tibia and expanded in the calf of a patient after total knee arthroplasty. A cystogram showed a direct communication between the joint cavity and the cyst, apparently associated with a screw that penetrated the tibial cortex. Histologic examination of the cyst showed an inflammatory reaction, including macrophages, foreign body giant cells, and metal and polyethylene particles. To our knowledge, this is the first case report illustrating a paraosseous cyst that developed after total knee arthroplasty. Wear debris from the total knee prosthesis may have been responsible for this unusual cyst.- - - - - - - - - - ranking = 1keywords = joint (Clic here for more details about this article) |
5/39. Intraosseous bioabsorbable poly-L-lactic acid screw presenting as a late foreign-body reaction: a case report.A 17-year-old woman complained of a localized painful swelling in her foot 30 months after internal fixation of a closed tarsometatarsal joint fracture with interfragmentary poly-L-lactic acid screws. Aspiration revealed a sterile abscess. Radiographs displayed an osteolytic lesion corresponding to a screw track in the first tarsometarsal joint. Formation of a draining sinus tract required surgical excision of a small granulomatous lesion. Histologic analysis found deposits of birefringent polymeric particles surrounded by a nonspecific foreign-body type reaction. This represents the first reported case of a draining sinus tract secondary to the use of polylactic acid screw fixation.- - - - - - - - - - ranking = 2keywords = joint (Clic here for more details about this article) |
6/39. Extensive osteolytic cystlike area associated with polyethylene wear debris adjacent to an aseptic, stable, uncemented unicompartmental knee prosthesis: case report.We present the case of a patient who after uncemented unicompartmental knee arthroplasty developed a large osteolytic cystlike area in the lateral aspect of the tibial metaphysis, contralateral to a well-fixed tibial component at revision surgery. The lesion contained fibrotic soft tissue, evidence of a foreign-body giant cell reaction and polyethylene particles, but no metal wear debris, infection, or malignancy. This case demonstrates that there is a direct communication between the joint cavity and the cyst.- - - - - - - - - - ranking = 1keywords = joint (Clic here for more details about this article) |
7/39. gout of the temporomandibular joint: pitfalls in diagnosis.gout is a frequent benign disease that rarely affects the temporomandibular joint (TMJ) alone. When it does, the disease is usually confined to the joint space and leads to pain and limitation of jaw opening (acute gout). The case described in this report is atypical in so far as it extended beyond the joint capsule into the pterygoid muscle and destroyed the head of the mandible, the temporal bone and the greater wing of the sphenoid bone. This clinical behaviour in combination with the radiographic appearance created the appearance of a benign but osteolytic lesion. The clinical, radiographic and biological features of gout in the TMJ are reviewed and treatment options are discussed.- - - - - - - - - - ranking = 7keywords = joint (Clic here for more details about this article) |
8/39. Synovial metaplasia, a specialized form of repair.Synovial metaplasia is a change seen most frequently in the tissues surrounding silicone breast prostheses and in healing tissue adjacent to joint prostheses. It has also been described in skin and soft tissues, most frequently in healing or healed traumatic or surgical wounds. We report a case of synovial metaplasia occurring in a hitherto unreported location, namely, adjacent to a silicone low-pressure voice prosthesis. A review of cases of synovial metaplasia reported in the literature revealed that in most cases, spaces that form adjacent to foreign material (most commonly silicone breast prostheses) and the smooth gliding surfaces of the foreign material that resist penetration by fibroblast processes are frequent associated findings that precede the occurrence of synovial metaplasia. Thus, synovial metaplasia might represent a specialized form of healing in cases that have this combination of physical features.- - - - - - - - - - ranking = 1keywords = joint (Clic here for more details about this article) |
9/39. Arthroscopic treatment of gunshot wounds to the shoulder.Two cases are presented that demonstrate the utility of arthroscopic intervention for the management of gunshot wounds to the shoulder. The first report involves a 24-year-old man with a retained bullet in his glenohumeral joint after a drive-by shooting The intra-articular bullet was retrieved arthroscopically avoiding chondral injury from the mechanical effects of a loose body as well as the potential local and systemic effects of lead toxicity. Irrigation and debridement was performed to evacuate joint debris, which could have served as a nidus for infection or inflammation. The other case describes a 19-year-old man who sustained a gunshot wound to the lateral portion of his upper arm resulting in a proximal humerus fracture along with a retained bullet in his subacromial space. The bullet was successfully removed arthroscopically avoiding a traditional exposure, which would have complicated his fracture care.- - - - - - - - - - ranking = 2keywords = joint (Clic here for more details about this article) |
10/39. Metal-backed patellar component failure in total knee arthroplasty presenting as a giant calf mass.Failure of total knee arthroplasty (TKA) caused by wear of the polyethylene-bearing surface of a metal-backed tibial platform or a metal-backed patellar component is a recognized complication. We present a case of a 78-year-old woman with a cystic mass in the left calf caused by metal wear debris from the failure of a Miller-Galante I TKA. The patient received a left TKA to treat advanced osteoarthritis in July 1990 and was lost to follow-up immediately after the operation. In December 1998, she presented at our clinic 2 days before admission, when an originally silent mass over the calf turned intolerably painful. A series of examinations revealed a calf mass caused by wear debris of total knee prosthesis and subsequent inflammation of the knee joint. curettage of the cyst and simultaneous revision TKA were successful in relieving her symptoms.- - - - - - - - - - ranking = 1keywords = joint (Clic here for more details about this article) |
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