Patellar Clunk Syndrome with Polyethylene Wear and Medial Synovial Hypertrophy after Mobile Bearing Total Knee Arthroplasty: A Case Report
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Patellar clunk syndrome after total knee arthroplasty is a complication that causes pain and poping or catching of patella.We experienced a case after mobile bearing total knee arthroplasty that medial synovial tissue was impinged between patella and femoral component and intra-articular fibrotic nodule of superior pole of patella was observed.Also, wear of Polyethylene were observed at anterio side.We resolved the patient symptom after excision of fibrotic nodule, synovectomy of medial synovial hypertrophy, and change of polyethylene.We report this case with literature review.Keywords:
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Satisfactory results were achieved by synovectomy in 24 of 26 rheumatoid knee joints. Follow-up studies averaged four years. Clinically, synovectomy arrested the rheumatoid process locally and prevented progressive joint destruction. The favorable results suggest that perhaps synovectomy of the knee joint should be performed more frequently in the patient with rheumatoid arthritis.
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The authors evaluate the results of synovectomy of the knee in 216 patients (83 men and 133 women) with rheumatic arthritis (RA); 35 patients with juvenile chronic arthritis (JCA) in the evaluated group account for 16,2%. On average 2.3 years have elapsed since the operation. They evaluate the peroperative macroscopic appearance of the synovial membrane, the damage of intraarticular structures, the effect of surgery on the range of movements. Comprehensive evaluation according to Aidem -Baker revealed very good results in 52.8%, good results in 36.1%, satisfactory results in 7.4% and poor results in 3.7%. Key words: surgical synovectomy, synovectomy of the knee, rheumatoid arthritis (RA), juvenile chronic arthritis (JCA).
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The indications for the subvastus approach in total knee arthroplasty are the same for a medial parapatellar approach in the appropriately selected patient. The subvastus approach does not violate the quadriceps mechanism, reduces the need for lateral retinacular release, preserves the patella blood supply, and, with our modifications, can be used in most cases.
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Synovectomy as a surgical procedure to relieve various affections of the knee joint dates back at least as far as 1877, when the German surgeon Volkmann employed it in the treatment of tuberculosis of the knee joint. During the next twenty years, the operation was used quite extensively in the treatment of this condition, and there was considerable discussion as to the relative merits of synovectomy and excision of the knee joint. It was apparently not used in the infectious types of arthritis until 1895, when Albertin1reported two cases of synovectomy for acute infectious arthritis following penetrating wounds of the knee. The first record found of a synovectomy in chronic arthritis is an article by Mignon,2in 1900, in which he reports the removal of the entire synovial membrane from the anterior compartment of the knee in a case of chronic traumatic arthritis with hydrops of the
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Synovectomy
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The general idea regarding knee joint synovectomy in rheumatoid arthritis and author's own surgical technique to fulfil this challenge is described. The protection of the extensor mechanism of the knee from surgical damage and the technique of removing as much rheumatoid inflammatory tissue from the joint as possible by combining it with meticulous debridement procedure are of primary importance. Postoperative management should vary depending on and preoperative findings in the joint operated upon. According to the author, these ideas and techniques could be applied to any other joint of a patient suffering from rheumatoid arthritis.
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