Synovectomy and Débridement of the Knee in Rheumatoid Arthritis

GEENS, STAF; Clayton, Mack L.; LEIDHOLT, JOHN D.; Smyth, Charley J.; BARTHOLOMEW, B. A.

doi:10.2106/00004623-196951040-00002

Cited by 54 publications

(23 citation statements)

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“…At least some of the beneficial effects may be related to synovectomy, which can still give acceptable results in moderately severely damaged joints. 7 We found it difficult to predict those who would do well, though large angular deformities and pronounced articular damage seemed to be adverse factors. Recurrence of angular deformity even after initial satisfactory correction was a relatively poor prognostic sign.…”

Section: Discussionmentioning

confidence: 83%

MacIntosh arthroplasty for the rheumatoid knee: a 10-year follow up.

Wordsworth¹,

Shakespeare²,

Mowat³

1985

Annals of the Rheumatic Diseases

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Section: Discussionmentioning

confidence: 83%

MacIntosh arthroplasty for the rheumatoid knee: a 10-year follow up.

Wordsworth¹,

Shakespeare²,

Mowat³

1985

Annals of the Rheumatic Diseases

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“…'5 Abraham et al, however, found there was no advantage in patellar resurfacing. 6 In my series of 275 total condylar knee replacements, carried out in a mainly rheumatoid population, about half had their patellae resurfaced. This group had less anterior knee pain, better subjective stability, and less reduction of bone stock in the longer term than those whose patellae were not resurfaced.…”

Section: Operative Techniquementioning

confidence: 99%

“…Unfortunately, preservation of the articular cartilage is no absolute guarantee of a good, longlasting result.5 A review carried out by Geens in 1970 of 500 cases from different centres showed that 80% of patients had some improvement after synovectomy. 6 The results of surgery must be related to the natural history of rheumatoid disease, but in a condition which is punctuated by good and bad spells over periods of time it is difficult to assess the precise value of this operation.…”

Section: Preoperative Assessmentmentioning

confidence: 99%

Surgery of the rheumatoid knee.

Abernethy¹

1990

Annals of the Rheumatic Diseases

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“…The disease can be treated with drugs but about 10% of patients remain unresponsive [3][4][5] to drug therapy, and removal or ablation of the synovial membrane, termed synovectomy, is necessary. Synovectomy can be accomplished surgically [6][7][8] or by the intra-articular injection of beta-emitting particles. 9,10 The latter method is not used in the United States because of concerns regarding leakage of the radionuclide from the joint.…”

Section: Introductionmentioning

confidence: 99%

Development and construction of a neutron beam line for accelerator‐based boron neutron capture synovectomy

2000

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A potential application of the 10B(n, alpha)7Li nuclear reaction for the treatment of rheumatoid arthritis, termed Boron Neutron Capture Synovectomy (BNCS), is under investigation. In an arthritic joint, the synovial lining becomes inflamed and is a source of great pain and discomfort for the afflicted patient. The goal of BNCS is to ablate the synovium, thereby eliminating the symptoms of the arthritis. A BNCS treatment would consist of an intra-articular injection of boron followed by neutron irradiation of the joint. Monte Carlo radiation transport calculations have been used to develop an accelerator-based epithermal neutron beam line for BNCS treatments. The model includes a moderator/reflector assembly, neutron producing target, target cooling system, and arthritic joint phantom. Single and parallel opposed beam irradiations have been modeled for the human knee, human finger, and rabbit knee joints. Additional reflectors, placed to the side and back of the joint, have been added to the model and have been shown to improve treatment times and skin doses by about a factor of 2. Several neutron-producing charged particle reactions have been examined for BNCS, including the 9Be(p,n) reaction at proton energies of 4 and 3.7 MeV, the 9Be(d,n) reaction at deuteron energies of 1.5 and 2.6 MeV, and the 7Li(p,n) reaction at a proton energy of 2.5 MeV. For an accelerator beam current of 1 mA and synovial boron uptake of 1000 ppm, the time to deliver a therapy dose of 10,000 RBEcGy ranges from 3 to 48 min, depending on the treated joint and the neutron producing charged particle reaction. The whole-body effective dose that a human would incur during a knee treatment has been estimated to be 3.6 rem or 0.75 rem, for 1000 ppm or 19,000 ppm synovial boron uptake, respectively, although the shielding configuration has not yet been optimized. The Monte Carlo design process culminated in the construction, installation, and testing of a dedicated BNCS beam line on the high-current tandem electrostatic accelerator at the Laboratory for Accelerator Beam Applications at the Massachusetts Institute of Technology.

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Synovectomy and Débridement of the Knee in Rheumatoid Arthritis

Cited by 54 publications

References 0 publications

MacIntosh arthroplasty for the rheumatoid knee: a 10-year follow up.

MacIntosh arthroplasty for the rheumatoid knee: a 10-year follow up.

Surgery of the rheumatoid knee.

Development and construction of a neutron beam line for accelerator‐based boron neutron capture synovectomy

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