Previous synovectomy or epiphyseal stapling and the influence on knee replacement in juvenile chronic arthritis

Lybäck, C. O.; Belt, Eero A.; Savolainen, H. A.; Lehtinen, Janne; Lybäck, C. C.; Lehto, Matti

doi:10.1007/s00264-004-0538-1

Cited by 10 publications

(8 citation statements)

References 15 publications

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“…Generally, the inflamed and thickened synovial tissue is preferred to be resected by most of the surgeons for inflammatory arthritis [12, 19]. However, in primary osteoarthritis, the advantages and disadvantages of combining the total capsulosynovectomy with total knee arthroplasty have not been determined.…”

Section: Introductionmentioning

confidence: 99%

The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study

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Çıçek

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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Section: Introductionmentioning

confidence: 99%

The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study

Kılıçarslan

Yalçın

Çıçek

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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“…Lybäck et al [ 16 ] conducted a case-control study of 77 patients with JIA who underwent total knee arthroplasty. Patients with prior synovectomy had shorter mean time to arthroplasty compared to patients with no synovectomy.…”

Section: Resultsmentioning

confidence: 99%

“…Publication dates ranged from 1969 to 2013. One article was a randomized trial, [10] 1 was a case-control study, [16] and all others were case series. [9,11,[13][14][15][17][18][19][20][21][22][23] Of the 11 articles, 13 were level-IV studies, and 1 was a level-II study (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Studies reported arthroplasty rates after synovectomy ranging from 2% to 15% and repeat synovectomy rates from 1% to 17%, with mean follow-up ranging from 3 to 7 years. [14,[17][18][19][20][21]23] Lybäck et al [16] conducted a case-control study of 77 patients with JIA who underwent total knee arthroplasty. Patients with prior synovectomy had shorter mean time to arthroplasty compared to patients with no synovectomy.…”

Section: Re-synovectomy and Arthroplastymentioning

confidence: 99%

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Synovectomy in juvenile idiopathic arthritis: A systematic review

et al. 2022

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Background: Juvenile idiopathic arthritis (JIA) is an inflammatory arthropathy with onset in children younger than 16 years. Treatment is primarily medical; however, surgical interventions, such as arthroscopic or open synovectomy, can be beneficial. Many studies have investigated synovectomy in JIA, but the results of these studies have not been synthesized to our knowledge. Therefore, we performed a systematic review of the literature reporting synovectomy as a treatment for JIA to provide clinical recommendations regarding its risks and benefits. Methods: On March 8, 2022, we searched the Cochrane Library, Embase, PubMed, Scopus, and Web of Science for studies evaluating clinical outcomes of open or arthroscopic synovectomy to treat JIA in patients younger than 18 years. We included only studies published in English and excluded studies of synovectomy to treat other arthropathies, septic arthritis, hemophilia, or foreign body arthropathy. The level of evidence for included studies was determined by using the Oxford Centre for Evidence-Based Medicine criteria. We qualitatively analyzed clinical outcomes data, including patient-reported pain relief, rates of symptom recurrence, and postoperative complications. Results: Of 428 articles assessed, 14 were included in our analysis. One was a randomized trial, 1 was a case-control study, and all others were case-series. Studies consistently reported that synovectomy was associated with improved function and decreased pain postoperatively. However, comparisons with modern medical therapy were lacking. Rates of arthritis recurrence varied, with increasing symptom recurrence with longer follow-up and re-synovectomy rates up to 15%. Oligoarticular disease and early disease course were associated with better response to synovectomy, whereas systemic and polyarticular disease were associated with poor response. Stiffness requiring manipulation under anesthesia was the most common complication (4% of all included patients). Conclusion: Although synovectomy is associated with positive functional outcomes and pain reduction postoperatively, there was inadequate comparison thus inadequate evidence to recommend it over modern medical therapy. The current literature suggests that synovectomy should be offered only to patients for whom medical management has failed, while noting the risks of decreased range of motion and symptom recurrence over time.

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“…However, in the knee, release requires both soft tissue and bony resection with particular attention to the posterior neurovascular structures. Previous synovectomy or epiphyseal stapling can influence surgical outcomes [2]. Soft tissue management in JRA patients is of paramount importance in determining a successful surgical outcome of total joint replacement.…”

Section: Concepts In Joint Replacement In Jramentioning

confidence: 99%

Total joint replacement in childhood arthritis

Kim¹,

Kahn²,

Figgie

2008

Curr Rheumatol Rep

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Juvenile rheumatoid arthritis poses a distinct challenge to pediatric rheumatologists and orthopedic surgeons. Recent developments in the medical management of juvenile rheumatoid arthritis have decreased the need for surgical intervention in this subset of patients; however, those patients who need surgery are often the most challenging cases due to their relatively small bone size, the complex deformity caused by soft tissue contractures, and the tendency for multiple joint involvement. Nonetheless, technologic improvements in implant design and surgical techniques have led to successful outcomes in otherwise debilitating conditions. A careful and coordinated approach to the surgical management of juvenile rheumatoid arthritis can lead to improved function and significant pain relief for children with rheumatoid arthritis.

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Previous synovectomy or epiphyseal stapling and the influence on knee replacement in juvenile chronic arthritis

Cited by 10 publications

References 15 publications

The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study

The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study

Synovectomy in juvenile idiopathic arthritis: A systematic review

Total joint replacement in childhood arthritis

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