Download PDF
J Knee Surg 2021; 34(01): 115-120
DOI: 10.1055/s-0040-1709181
Original Article

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

Ali Utkan
1   Department of Orthopaedics and Traumatology, Ankara Sehir Hastanesi, Ankara, Turkey
,
Emrah Caliskan 
2   Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey
,
Batuhan Gencer
1   Department of Orthopaedics and Traumatology, Ankara Sehir Hastanesi, Ankara, Turkey
,
Bulent Ozkurt
1   Department of Orthopaedics and Traumatology, Ankara Sehir Hastanesi, Ankara, Turkey
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Although there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

Keywords

synovium - total knee arthroplasty - pathological analysis - lipoma arborescence


Publication History

Received: 27 November 2019

Accepted: 16 February 2020

Article published online:
30 April 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Pathology and Clinical Laboratory Services. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 1996
    Google Scholar
  • 2 Nakhleh R, Fitzgibbons P. Quality Improvement Manual in Anatomic Pathology. Northfield, IL: College of American Pathologists; 2002
    Google Scholar
  • 3 Clark CR, Bauer T. Routine pathological examination of operative specimens from primary total hip and total knee replacement: another look. J Bone Joint Surg Am 2000; 82 (11) 1529-1530
    CrossrefPubMedGoogle Scholar
  • 4 Culp JA, Hartigan BJ, Stern PJ. A brief note. Ask yourself, why? A cost effective look at routine pathologic examination of specimens using the trapezium. J Bone Joint Surg Am 2001; 83 (05) 722-724
    CrossrefPubMedGoogle Scholar
  • 5 Kocher MS, Erens G, Thornhill TS, Ready JE. Cost and effectiveness of routine pathological examination of operative specimens obtained during primary total hip and knee replacement in patients with osteoarthritis. J Bone Joint Surg Am 2000; 82 (11) 1531-1535
    CrossrefPubMedGoogle Scholar
  • 6 Niggemeyer O, Steinhagen J, Zustin J, Rüther W. The value of routine histopathology during hip arthroplasty in patients with degenerative and inflammatory arthritis. Hip Int 2011; 21 (01) 98-106
    CrossrefPubMedGoogle Scholar
  • 7 College of American Pathologists. Laboratory Accreditation Program Manual. Northfield, IL: College of American Pathologists; 2013
    Google Scholar
  • 8 Tuğay BU, Tuğay N, Güney H, Kınıklı Gİ, Yüksel İ, Atilla B. Oxford Knee score: cross-cultural adaptation and validation of the Turkish version in patients with osteoarthritis of the knee. Acta Orthop Traumatol Turc 2016; 50 (02) 198-206
    PubMedGoogle Scholar
  • 9 Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res 2016; 474 (08) 1886-1893
    CrossrefPubMedGoogle Scholar
  • 10 Clement ND, MacDonald D, Simpson AH. The minimal clinically important difference in the Oxford knee score and Short form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1933-1939
    Google Scholar
  • 11 Lawrence T, Moskal JT, Diduch DR. Analysis of routine histological evaluation of tissues removed during primary hip and knee arthroplasty. J Bone Joint Surg Am 1999; 81 (07) 926-931
    CrossrefPubMedGoogle Scholar
  • 12 Greene JW, Zois T, Deshmukh A, Cushner FD, Scuderi GR. Routine examination of pathology specimens following knee arthroscopy: a cost-effectiveness analysis. J Bone Joint Surg Am 2014; 96 (11) 917-921
    CrossrefPubMedGoogle Scholar
  • 13 Schmitt J, Lange T, Günther KP. et al. Indication criteria for total knee arthroplasty in patients with osteoarthritis—a multi-perspective consensus study. Z Orthop Unfall 2017; 155 (05) 539-548
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Sharma H, Rana B, Mahendra A, Jane MJ, Reid R. Outcome of 17 pigmented villonodular synovitis (PVNS) of the knee at 6 years mean follow-up. Knee 2007; 14 (05) 390-394
    CrossrefPubMedGoogle Scholar
  • 15 Akinci O, Akalin Y, İncesu M, Eren A. Long-term results of surgical treatment of pigmented villonodular synovitis of the knee. Acta Orthop Traumatol Turc 2011; 45 (03) 149-155
    CrossrefPubMedGoogle Scholar
  • 16 Nishida Y, Tsukushi S, Nakashima H. et al. Osteochondral destruction in pigmented villonodular synovitis during the clinical course. J Rheumatol 2012; 39 (02) 345-351
    CrossrefPubMedGoogle Scholar
  • 17 Klompmaker J, Veth RP, Robinson PH, Molenaar WM, Nielsen HK. Pigmented villonodular synovitis. Arch Orthop Trauma Surg 1990; 109 (04) 205-210
    CrossrefPubMedGoogle Scholar
  • 18 Lei P, Sun R, Liu H, Zhu J, Wen T, Hu Y. Prognosis of advanced tenosynovial giant cell tumor of the knee diagnosed during total knee arthroplasty. J Arthroplasty 2017; 32 (06) 1850-1855
    CrossrefPubMedGoogle Scholar
  • 19 Xie GP, Jiang N, Liang CX. et al. Pigmented villonodular synovitis: a retrospective multicenter study of 237 cases. PLoS One 2015; 10 (03) e0121451
    CrossrefPubMedGoogle Scholar
  • 20 Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 2010; 13 (02) 158-164
    CrossrefPubMedGoogle Scholar
  • 21 Kulkarni HG, Kulkarni GS, Kulkarni PG. Lipoma arborescens—Eyes See What Mind Knows!. J Orthop Case Rep 2017; 7 (05) 59-62
    PubMedGoogle Scholar
  • 22 Soler T, Rodríguez E, Bargiela A, Da Riba M. Lipoma arborescens of the knee: MR characteristics in 13 joints. J Comput Assist Tomogr 1998; 22 (04) 605-609
    CrossrefPubMedGoogle Scholar
  • 23 Hallel T, Lew S, Bansal M. Villous lipomatous proliferation of the synovial membrane (lipoma arborescens). J Bone Joint Surg Am 1988; 70 (02) 264-270
    CrossrefPubMedGoogle Scholar
  • 24 Malkoç M, Korkmaz Ö. Results of arthroscopic synovectomy for treatment of synovial lipomatosis (Lipoma Arborescens) of the knee. J Knee Surg 2018; 31 (06) 536-540
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Healy WL, Della Valle CJ, Iorio R. et al. Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clin Orthop Relat Res 2013; 471 (01) 215-220
    CrossrefPubMedGoogle Scholar
  • 26 Feng B, Lin J, Jin J, Qian WW, Wang W, Weng XS. Thirty-day postoperative complications following primary total knee arthroplasty. A retrospective study of incidence and risk factors at a single center in China. Chin Med J 2017; 130 (21) 2551-2556
    CrossrefPubMedGoogle Scholar
  • 27 Crockarell JR, Guyton JL. Arthroplasty of the knee. In: Canale TS, Beaty JH. eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia: Mosby Inc., Elsevier; 2008: 241-311
    Google Scholar