Results of Arthroscopic Synovectomy for Treatment of Synovial Lipomatosis (Lipoma Arborescens) of the Knee

Malkoç, Melih; Korkmaz, Özgür

doi:10.1055/s-0037-1604440

Cited by 16 publications

(22 citation statements)

References 21 publications

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“…The cause of LA is unknown. It has been associated with osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, joint trauma, diabetes mellitus and high body mass index 3–11. There is a hypothesis that LA may be due to a chronic inflammatory process, as evidenced by mononuclear cell infiltration in the synovial membrane 1.…”

Section: Discussionmentioning

confidence: 99%

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Lipoma arborescens: a rare cause of clicking in the knee

Nambiar¹,

Onggo

Jacobson

2019

BMJ Case Rep

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Lipoma arborescens (LA) is a rare condition with synovial membrane lipomatous proliferation. It most commonly affects the knee joint, in the suprapatellar pouch. It can present as a painful knee with an effusion. Diagnosis is via MRI demonstrating a synovial mass with frond-like appearance, and histology showing mature adipose cells, with an overlying synovial membrane. Treatment options include non-operative measures with analgesia, or operative intervention to resect the lesion. We describe a unique case of LA present in the anterolateral knee joint, presenting with persistent painful clicking in the knee. The patient underwent an open total resection of the lesion, with resolution of symptoms.

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Section: Discussionmentioning

confidence: 99%

“…Recurrence following surgical excision is rare 11 16 18 19. An isolated case of treatment by Yttrium-90 radiosynovectomy has been reported, without further recurrence 20…”

Section: Discussionmentioning

confidence: 99%

Lipoma arborescens: a rare cause of clicking in the knee

Nambiar¹,

Onggo

Jacobson

2019

BMJ Case Rep

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“…Synovectomy is performed during primary total knee arthroplasty (TKA) for KOA mainly in the light of a surgeon’s experience and preference [6]. Orthopedic surgeons administering synovectomy claim that synovitis is the main cause of knee joint swelling and pain [7]. In addition, synovial inflammation is a risk factor for unsatisfactory results after TKA [8], because it restricts the range of motion [9], and is associated with recurrent knee hemarthrosis and impingement [10].…”

Section: Introductionmentioning

confidence: 99%

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2019

J Orthop Surg Res

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Background During primary total knee arthroplasty (TKA), synovectomy as a part of the procedure has been recommended to relieve pain and inflammation of the synovium, but there is a controversy about it due to increased bleeding. In this meta-analysis, the aim is to answer whether synovectomy should be performed routinely during TKA for symptomatic knee osteoarthritis (KOA). Methods Relevant randomized controlled trials (RCTs) on synovectomy were retrieved through database searches of PubMed, Embase, Web of Science, and Cochrane Library up to February 2019. Studies that compared postoperative pain, clinical Knee Society Score (KSS), functional KSS, range of motion (ROM), drainage, pre- and postoperative hemoglobin difference, transfusion rate, operative time, and/or complications were included in the meta-analysis. Review Manager 5.3.0 was used for meta-analysis. Results We included 5 RCTs with 542 knees. Pooled results indicated that the synovectomy group was associated with more blood loss via drainage (WMD = − 99.41, 95% CI − 153.75 to − 45.08, P = 0.0003) and pre- and postoperative hemoglobin difference (WMD = − 0.93, 95% CI − 1.33 to − 0.5, P < 0.00001), compared with the non-synovectomy group. No statistically significant differences were demonstrated between both groups in postoperative pain, clinical KSS, functional KSS, ROM, transfusion rate, or complications ( P > 0.05). Conclusions The current evidence demonstrates that performing synovectomy in primary TKA for symptomatic KOA does not have any clinical benefit. It increases postsurgical blood loss. Surgeons routinely undertaking synovectomy should deliberate whether this is clinically indicated and consider limiting resection, if possible.

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“…Following Synovectomy combined with other specific surgical procedures have reported favorable results in most of the studies. 4 Surgery in the form of total knee arthroplasty (TKA) remains the most effective method of managing late-stage cases due to a complete lack of disease-modifying osteoarthritis agents. 5 It is the surgeon's decision to do synovectomy while doing total knee replacement.…”

mentioning

confidence: 99%

“…6 Minimal amount of synovium as possible should be removed as recommended by Krackow et al 6 Because of improving knee implant designs and a lowering of thresholds for surgeons to offer surgery, there are an increasing number of patients receiving TKA. 4…”

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confidence: 99%

Effectiveness of Synovectomy in TKA- A Comparative Study between Complete and Partial Synovectomy

Lebaku¹,

Gangireddi²

2019

jebmh

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BACKGROUND Surgical management of late stage Osteoarthritis knee is Total Knee Arthroplasty. During this surgery, hypertrophied synovial membrane is noticed. In some patients, total synovectomy was performed. In some patients, partial synovectomy was performed. The main objective is to consider the amount of blood loss, assess recruitment rates and protocol adherence in these patients. METHODS We performed a single-centre pilot RCT. Patients with inflamed synovium were randomised to receive synovectomy versus a control group that did not undergo synovectomy. By measuring patient enrolment, completeness of follow-up, and safety via haemoglobin decrease and documentation of adverse events, feasibility was determined. RESULTS We screened 187 patients' eligible patients, who progressed through to randomization. All made it to the 12-month follow-up, indicating good protocol adherence. There were no major differences in adverse events or haemoglobin decrease demonstrating acceptable safety. Outcomes relating to satisfaction were reliably obtained. CONCLUSIONS Patients with inflamed synovium of the knee who are due to undergo TKA can be reliably recruited to a randomised trial and synovectomy can be performed safely. To assess whether routine synovectomy would improve outcomes in these patients, large number is needed to be screened to identify eligible participants, and therefore, a multi-centre trial would be required.

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Results of Arthroscopic Synovectomy for Treatment of Synovial Lipomatosis (Lipoma Arborescens) of the Knee

Cited by 16 publications

References 21 publications

Lipoma arborescens: a rare cause of clicking in the knee

Lipoma arborescens: a rare cause of clicking in the knee

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Effectiveness of Synovectomy in TKA- A Comparative Study between Complete and Partial Synovectomy

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