Open Synovectomy for Chronic Infectious Arthritis of the Wrist

Sanglim Lee; Sueen Sohn; Suk Ha Jeon; Yong-Woon Shin

doi:10.0000/jkssh.2012.17.4.166

Journal List > J Korean Soc Surg Hand > v.17(4) > 1106409

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Lee, Sohn, Jeon, and Shin: Open Synovectomy for Chronic Infectious Arthritis of the Wrist

Original Article

Journal of the Korean Society for Surgery of the Hand

Journal of the Korean Society for Surgery of the Hand 2012; 17(4): 166-172.

Published online: 31 December 2012

DOI: https://doi.org/10.0000/jkssh.2012.17.4.166

Open Synovectomy for Chronic Infectious Arthritis of the Wrist

Sanglim Lee¹, Sueen Sohn¹, Suk Ha Jeon², Yong-Woon Shin¹

¹Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

²Department of Orthopedic Surgery, National Medical Center, Seoul, Korea.

Correspondence to: Yong-Woon Shin. Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. TEL: +82-2-950-1026, FAX: +82-2-937-8873, woonysos@hanmail.net

Received 2 September 2012 Revised 14 October 2012 Accepted 24 October 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We reported the results of open synovectomy for chronic infectious arthritis of the wrist.

Methods

Fifteen patients who had chronic infectious arthritis of the wrist and underwent open synovectomy were reviewed retrospectively baesd on preoperative periods, symptoms, results of laboratory tests, radiological findings including magnetic resonance imaging (MRI), hospitalization period, and others. Pain scale and subjective satisfaction were checked by phone interview.

Results

Average preoperative period was 96.1 days. Pain on motion and edema were observed in all cases. Four patients had positive bacterial cultures and three were identified as tuberculous infection. Signal changes of bones were observed in MRI of 10 patients. Osteomyelitis was found in 8 patients during the operation and bone resection or fusion should be performed in three. Average number of operation times was 1.53.

Conclusion

When the patients show chronic swelling and pain on motion of the wrist, diagnostic work-ups for chronic infectious arthritis should be performed including arthrocentesis and MRI. Treatment including open synovectomy should be done immediately.

Keywords: Wrist, Chronic infectious arthritis, Arthrocentesis, Magnetic resonance imaging, Mycobacterium

Figures and Tables

Fig. 1

Wrist magnetic resonance imaging of 68-year-old female patient, who visited 4 months after onset of the symptoms, shows diffuse synovial hypertrophy, joint effusion, and multiple bony erosions and marrow edema.

Table 1

Clinical and radiologic data of the patients

MRI: magnetic resonance imaging, S: scaphoid, H: hamate, NTM: nontuberculosis mycobacteria, R: distal radius, C: capitate, MSCNS: methicillin-sensitive coagulase negative Staphylococcus, L: lunate, Tq: triquetrum, Tp: trapezium, MC: metacarpals, U: distal ulna, UC: ulnocarpal (joint), DRUJ: distal radioulnar (joint), RC: radiocarpal (joint), MSSA: methicillin-sensitive Staphylococcus aureus, MRCNS: methicillin-resistance coagulase negative Staphylococcus.

Notes

This study was presented briefly in 2011-The 55th Annual Fall Congress of the Korean Orthopedic Association.

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