Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Synovial Entrapment: A Complication of Posterior Stabilized Total Knee Arthroplasty

Synovial Entrapment: A Complication of Posterior Stabilized Total Knee Arthroplasty Background: We observed a complication of posterior stabilized total knee arthroplasty involving hypertrophy of tissue proximal to the patella associated with pain during active knee extension from 90° of flexion. The purpose of this paper was to describe synovial entrapment and to determine if design features of the prosthesis predispose patients to the complication. Methods: Between April 1990 and June 1999, we performed 459 consecutive posterior stabilized primary total knee arthroplasties using three prosthetic designs with different femoral intercondylar geometries. We identified twenty-six patients (twenty-seven knees) in whom arthroscopic débridement of the knee or open arthrotomy with débridement of the knee had been subsequently performed because of a diagnosis of synovial entrapment. We reviewed the records of these patients to identify the knee components that had been used and the symptoms and conditions that necessitated additional treatment. Results: Symptoms (grating, crepitation, and pain with active knee extension from 90°) necessitating subsequent débridement occurred in 13.5% (nineteen) of 141 knees treated with the Anatomic Modular Knee-Congruency implant, 3.8% (eight) of 212 treated with the Anatomic Modular Knee-Posterior Stabilized implant, and none of the 106 treated with the Press Fit Condylar Sigma-Posterior Stabilized implant. All patients had difficulty rising from a chair and climbing stairs; however, none had symptoms when standing or walking. No patient had a patellar clunk. The symptoms occurred at a mean of seven months after the arthroplasty in the patients with an Anatomic Modular Knee-Congruency implant and at a mean of twenty months after the arthroplasty in those with an Anatomic Modular Knee-Posterior Stabilized implant. Débridement of the frond-like hypertrophic synovial tissue at the distal aspect of the quadriceps tendon alleviated symptoms in all patients. No nodules were identified during the arthroscopy. Conclusions: Synovial entrapment is characterized by hypertrophic synovial tissue at the superior pole of the patella. Use of a posterior stabilized femoral component with a proximally positioned or wide femoral box is more likely to result in this complication. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Bone and Joint Surgery Wolters Kluwer Health

Synovial Entrapment: A Complication of Posterior Stabilized Total Knee Arthroplasty

Download PDF
6 pages

Loading next page...
 
/lp/jb-js/synovial-entrapment-a-complication-of-posterior-stabilized-total-knee-XzpL1eCWXk

References

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Wolters Kluwer Health
Copyright
Copyright © 2002 by The Journal of Bone and Joint Surgery, Inc.
ISSN
0021-9355
Publisher site
See Article on Publisher Site

Abstract

Background: We observed a complication of posterior stabilized total knee arthroplasty involving hypertrophy of tissue proximal to the patella associated with pain during active knee extension from 90° of flexion. The purpose of this paper was to describe synovial entrapment and to determine if design features of the prosthesis predispose patients to the complication. Methods: Between April 1990 and June 1999, we performed 459 consecutive posterior stabilized primary total knee arthroplasties using three prosthetic designs with different femoral intercondylar geometries. We identified twenty-six patients (twenty-seven knees) in whom arthroscopic débridement of the knee or open arthrotomy with débridement of the knee had been subsequently performed because of a diagnosis of synovial entrapment. We reviewed the records of these patients to identify the knee components that had been used and the symptoms and conditions that necessitated additional treatment. Results: Symptoms (grating, crepitation, and pain with active knee extension from 90°) necessitating subsequent débridement occurred in 13.5% (nineteen) of 141 knees treated with the Anatomic Modular Knee-Congruency implant, 3.8% (eight) of 212 treated with the Anatomic Modular Knee-Posterior Stabilized implant, and none of the 106 treated with the Press Fit Condylar Sigma-Posterior Stabilized implant. All patients had difficulty rising from a chair and climbing stairs; however, none had symptoms when standing or walking. No patient had a patellar clunk. The symptoms occurred at a mean of seven months after the arthroplasty in the patients with an Anatomic Modular Knee-Congruency implant and at a mean of twenty months after the arthroplasty in those with an Anatomic Modular Knee-Posterior Stabilized implant. Débridement of the frond-like hypertrophic synovial tissue at the distal aspect of the quadriceps tendon alleviated symptoms in all patients. No nodules were identified during the arthroscopy. Conclusions: Synovial entrapment is characterized by hypertrophic synovial tissue at the superior pole of the patella. Use of a posterior stabilized femoral component with a proximally positioned or wide femoral box is more likely to result in this complication.

Journal

Journal of Bone and Joint Surgery – Wolters Kluwer Health

Published: Dec 1, 2002

There are no references for this article.