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[Synovectomy in the treatment of acute arthritis caused by Micrococcus pyogenes]
Abstract:
In addition to antibiotic therapy associated with immobilization in a plaster cast, effective in the majority of cases of acute arthritis caused by St. pyogenes and resection-arthrodesis which is necessary in the stage of osteoarthritis, synovectomy occupies an intermediate position. During a period--possibly not a short one--when the lesions are still purely synovial and do not regress under medical treatment, their ablation permits recovery from the infection with restoration of the functional activity of the joint. The experience is based on 26 observations (19 knees, 3 hips, 2 shoulders, 1 thumb, 1 metacarpo-phalangeal lesion). In 2/3 of cases these arthritides were iatrogenic (13 after cortisone infiltration, 4 postoperative, 1 haematogenic from i.v. catheterization). Synovectomy should be complete; haemostasis must be rigorous; an aspiration drain is left in place for 5 or 6 days; additional immobilization in plaster is not obligatory; antibiotic treatment is continued until the BSR has returned to normal. As regards control of the infection, this was obtained in 19 of 26 operations. As regards function, in 10 of these cases the results were very good, in 7 good (slight persistent restriction of movement), in only 2 cases the results were unsatisfactory. The factors that appear to affect the results are on the one hand rigorous technique and on the other sufficiently early operation before the lesions have become too fully established. However, a study of arthritides after cortisone infiltration of previously affected joints has shown that even relatively late operation can lead to satisfactory results (9 of 13).
Insights
Synovectomy offers an intermediate treatment for certain types of arthritis, particularly when lesions are confined to the synovium. This surgical intervention can lead to infection control and functional recovery in many cases.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Rheumatology
Background:
- Acute arthritis, often caused by Streptococcus pyogenes, typically responds to antibiotic therapy and immobilization.
- Osteoarthritis may necessitate resection-arthrodesis.
- Synovectomy presents an alternative treatment option for specific joint infections.
Purpose of the Study:
- To evaluate the efficacy of synovectomy in treating synovial joint infections.
- To assess functional recovery and infection control following synovectomy.
- To identify factors influencing the success of synovectomy.
Main Methods:
- The study reviewed 26 cases of joint infections treated with synovectomy.
- Iatrogenic causes accounted for the majority of cases (2/3), including post-cortisone infiltration and post-operative infections.
- Surgical technique emphasized complete synovectomy, rigorous hemostasis, and post-operative drain placement.
Main Results:
- Infection control was achieved in 19 out of 26 operations.
- Functional outcomes were very good in 10 cases, good in 7, and unsatisfactory in 2.
- Early operation and meticulous surgical technique were associated with better results, though late operations also yielded satisfactory outcomes in some cases.
Conclusions:
- Synovectomy is an effective procedure for managing synovial joint infections when performed early and with rigorous technique.
- The procedure can restore joint function and control infection, especially in cases unresponsive to medical management.
- Even in later stages, particularly after cortisone infiltration, synovectomy can provide favorable results.