RESUMO
Calcium pyrophosphate deposition disease (CPPD), known as pseudogout, is characterized by the accumulation of calcium pyrophosphate crystals in musculoskeletal structures, primarily joints. While CPPD commonly affects various joints, involvement in the cervical spine leading to myelopathy is rare. Surgical intervention becomes necessary when conservative measures fail, but reports on full endoscopic surgeries are extremely rare. We present two successful cases where full endoscopic systems were used for CPPD removal in the cervical spine. The surgical technique involved a full endoscopic approach, adapting the previously reported technique for unilateral laminotomy bilateral decompression. Full-endoscopic removal of cervical CPPD inducing myelopathy were successfully removed with good clinical and radiologic outcomes. The scarcity of endoscopic cases for cervical ligamentum flavum CPPD is attributed to the condition's rarity. However, our successful cases advocate for endoscopic surgery as a potential primary treatment option for CPPD-induced cervical myelopathy, especially in elderly patients or those with previous cervical operation histories. This experience encourages the consideration of endoscopic surgery for managing cervical ligamentum flavum CPPD as a viable alternative.
Assuntos
Condrocalcinose , Ligamento Amarelo , Doenças da Medula Espinal , Humanos , Idoso , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/cirurgia , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , PescoçoRESUMO
PURPOSE: Meniscal tears or histological meniscal calcifications (in the absence of radiological chondrocalcinosis) are frequent in osteoarthritis. Whether lateral meniscal lesions influence clinical outcomes after medial unicompartmental knee arthroplasty (UKA) is unknown. METHODS: We analyzed 130 patients (130 knees) with medial unicompartmental knee arthroplasties between 2005 and 2015. These 130 knees had full articular cartilage thickness in the lateral compartment and no radiological chondrocalcinosis on preoperative radiographs. The lateral meniscus was analyzed with preoperative MRI and a biopsy of the anterior horn at the time of surgery. Synovial fluid was collected and analyzed for calcium pyrophosphate dihydrate crystal deposition (CPPD crystals). Lateral meniscal tears were untreated when detected on MRI or during surgery, with the hypothesis that these tears on the opposite compartment would remain asymptomatic in medial UKA. At average 10-year follow-up, patients were evaluated with clinical and radiographic outcome, with a focus on the risk of joint space narrowing of the lateral femorotibial compartment. RESULTS: CPPD crystals were present in the synovial fluid of 70 knees. Lateral meniscal tears were seen on MRI in 34 (49%) normal meniscuses of the 60 knees without CPPD crystals and in six other knees without histological meniscal calcification despite CPPD crystals. Histological calcification was present on 61 lateral meniscuses with 53 meniscal tears. The results showed no significant differences in the clinical outcomes between knees with lateral meniscal tears or lateral meniscal histological chondrocalcinosis or both lesions and those without these conditions. Additionally, radiographic progression of osteoarthritis in the opposite femorotibial compartment of the knee was not more frequent in patients with these meniscal issues. The ten year cumulative survival rates, measured by the need for total knee arthroplasty, were 91% for knees without meniscal lesions and 92% for knees with these lesions. CONCLUSION: On this basis, treatment of meniscal tears of the lateral compartment and routine aspiration of the knee to assess for birefringent crystals in the planning of medial UKA do not appear necessary.
Assuntos
Artroplastia do Joelho , Doenças das Cartilagens , Condrocalcinose , Traumatismos do Joelho , Osteoartrite do Joelho , Humanos , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Meniscos Tibiais/patologia , Condrocalcinose/complicações , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Articulação do Joelho/patologia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/patologia , Traumatismos do Joelho/cirurgia , Doenças das Cartilagens/cirurgiaRESUMO
This cross-sectional study aims to evaluate the predictors, outcomes, and resource utilization of total knee arthroplasty (TKA) in calcium pyrophosphate deposition disease (CPPD) patients. We used the US National Inpatient Sample database to identify CPPD and non-CPPD who underwent TKA from 2006 to 2014. Data collection included patient demographics and comorbidities. Outcomes following TKA included in-hospital mortality, complications, length of hospitalization, hospital charges, and disposition. Among the 5,564,005 patients who have undergone TKA, 11,529 (0.20%) had CPPD, with a median age of 72 years, and 53.7% were females. Compared with non-CPPD, patients with CPPD were more likely to be older (mean 72 vs 66 years; p < 0.001), male, white, and have Medicare insurance. CPPD patients were more likely to have ≥ 2 comorbidities calculated by the Charlson Comorbidity Index and discharge to an inpatient/rehabilitation facility. Regarding inpatient complications, myocardial infarction and knee reoperation were significantly more common in CPPD patients. TKA in CPPD patients was associated with significantly higher odds of increased length of stay (> 3 days) than those without CPPD (OR 1.43, 95% CI 1.37-1.49). There was no significant difference in the in-hospital mortality even after adjusting for possible confounders. CPPD patients who underwent TKA were more likely to have a longer hospital stay and discharge to a non-home setting than non-CPPD. Also, CPPD patients had a higher comorbidity burden and risk for myocardial infarction and reoperation.Key Points⢠This is the largest study to analyze data of CPPD patients who underwent TKA and compare them with non-CPPD patients, using a large nationwide database.⢠Compared to non-CPPD patients, TKA in CPPD patients is associated with a greater length of stay and disposition to a nursing/rehabilitation facility.⢠In-hospital complications such as myocardial infarction and reoperation were more frequently observed in CPPD patients than non-CPPD.⢠The results of this study should alert healthcare providers to develop strategies in order to improve outcomes of CPPD patients undergoing TKA.
Assuntos
Artroplastia do Joelho , Condrocalcinose , Infarto do Miocárdio , Idoso , Artroplastia do Joelho/efeitos adversos , Condrocalcinose/complicações , Condrocalcinose/epidemiologia , Condrocalcinose/cirurgia , Estudos Transversais , Feminino , Humanos , Tempo de Internação , Masculino , Medicare , Infarto do Miocárdio/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Tophaceous pseudogout is a rare variant of the calcium pyrophosphate dihydrate (CPPD) disorder, with predilection for the TMJ. It is characterized by calcific deposits composed of rhomboid- or rectangular-shaped crystals that exhibit birefringence when examined under polarized light. We hereby present a case of a 65-year-old man with left pre-auricular tenderness and malocclusion. CT imaging was notable for a left TMJ mineralized mass with erosion of the condylar head. Treatment involved excision of the mass with eminectomy, condylectomy, and a stock total TMJ reconstruction. In this report, important considerations for diagnosis, biopsy, and surgical treatment with emphasis on reconstruction for tophaceous pseudogout of the TMJ have been highlighted by the authors.
Assuntos
Condrocalcinose , Idoso , Biópsia , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/cirurgia , Humanos , Masculino , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/patologia , Articulação Temporomandibular/cirurgiaRESUMO
PURPOSE: There are contentious data about the role calcium pyrophosphate (CPP) crystals and chondrocalcinosis (CC) play in the progression of osteoarthritis (OA), as well as in the outcomes after knee arthroplasty. Hence, the purpose of this systematic review was to analyse the clinical and functional outcome, progression of OA and prosthesis survivorship after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in patients with CC compared to patients without CC. METHODS: A systematic review of the literature in PubMed, Medline, Embase and Web of Science was performed using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA) guidelines. Articles which reported the outcome and survival rates of prosthesis after TKA or UKA in patients with CC were included. RESULTS: A total of 3718 patient knees were included in eight selected publications, with a median sample sizes of 234 knees (range 78-1000) and 954 knees (range 408-1500) for publications including UKA and TKA, respectively. At time of surgery, the mean age was 69 years and the prevalence for CC ranged from 12.6 to 36%. Chondrocalcinosis did not significantly influence the functional and clinical outcome, the implant survival as well as the radiologic progression of OA disease after UKA and TKA. CONCLUSION: The presence of CPP crystals in tissue samples, synovial fluid or evidence of calcifications on preoperative radiographs did not significantly influence the postoperative functional and activity scores. It also had no significant influence on prosthesis survival rate, whether it was a UKA or a TKA. This study shows that the impact of a subclinical form of chondrocalcinosis may not be of clinical relevance in the context of arthroplasty. LEVEL OF EVIDENCE: IV.
Assuntos
Artroplastia do Joelho , Condrocalcinose , Prótese do Joelho , Osteoartrite do Joelho , Idoso , Condrocalcinose/complicações , Condrocalcinose/cirurgia , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/cirurgia , Falha de Prótese , Resultado do TratamentoRESUMO
Pseudogout, also known as calcium pyrophosphate deposition disease, is an inflammatory arthropathy that primarily occurs in the peripheral joints, such as the knee or elbow. Spinal pseudogout is uncommon, and neck pain is its most common clinical manifestation. However, cervical myeloradiculopathy as an initial presentation of pseudogout attack of the ligamentum flavum has rarely been reported in the literature. We report a case of a 65-year-old woman who presented with neck pain, bilateral finger numbness, and left-sided upper extremity weakness. Magnetic resonance images showed an epidural mass at the C4-5 level, compressing the spinal cord. Following laminectomy with removal of the calcified mass, the profound neurologic deficits gradually recovered. A pathological examination confirmed the diagnosis of cervical pseudogout.
Assuntos
Medula Cervical/diagnóstico por imagem , Condrocalcinose/complicações , Ligamento Amarelo/diagnóstico por imagem , Radiculopatia/etiologia , Doenças da Medula Espinal/etiologia , Idoso , Medula Cervical/cirurgia , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/cirurgia , Feminino , Humanos , Laminectomia , Ligamento Amarelo/cirurgia , Imageamento por Ressonância Magnética , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: There are few reports of cervical myelopathy caused by an attack of subaxial calcium pyrophosphate dihydrate (CPPD) deposition. Moreover, there has been no report on cervical myelopathy by subaxial CPPD deposition with simultaneous asymptomatic crowned dens syndrome (CDS) at the same time. CASE PRESENTATION: The first case was a 68-year-old male complaining of cervical myelopathic symptoms. Plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) findings revealed spinal cord compression by calcified round lesions at C4 as well as a calcified lesion behind the dens. The second case was a 77-year-old female complaining of cervical myelopathic symptoms. Plain radiographs, CT and MRI findings revealed spinal cord compression by calcified round lesions at C3 and C4 as well as a calcified lesion behind the dens. In both cases, we believed that the calcified lesion behind the dens was an asymptomatic lesion. Therefore, the first patient received decompressive laminectomy of C3 and C4, removal of calcified round lesions, and posterior fixation from C3 to C5 due to associated kyphosis. The second patient underwent decompressive laminectomy of C3 and C4 and removal of calcified round lesions. Microscopic examination under polarized light showed dark blue calcifications with rhomboid crystals that were positively birefringent. The findings were consistent with those of CPPD. CONCLUSIONS: This is the first study to report cervical myelopathy caused by subaxial CPPD deposition with simultaneous asymptomatic CDS. Surgical removal of the subaxial CPPD deposition alone achieved a satisfactory surgical outcome without recurrence.
Assuntos
Vértebras Cervicais , Condrocalcinose , Doenças da Medula Espinal , Idoso , Pirofosfato de Cálcio , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Condrocalcinose/complicações , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/cirurgia , Feminino , Humanos , Masculino , CervicalgiaRESUMO
INTRODUCTION: In total knee replacement surgery, medio-lateral knee balancing is recognized as the key to achieving satisfactory functional results. But it may not be enough to stabilize the flexion gap using deep-dished implants. We achieved flexion gap balance by oversizing the femoral component, thus increasing the posterior condylar offset (PCO). The purpose of this study was to describe the applicability of this technique and to test whether it produced adverse effects on medium-term outcomes. We hypothesized that it would not compromise the results if used properly. We therefore asked: (1) at how many cases of flexion gap balance would require oversizing the femoral component; (2) if femoral components oversizing would modify the mid-term results as per forgotten joint score (FJS) scores and whether flexion gain would be comparable to patients in whom it was not increased. MATERIALS AND METHODS: Ninety-four patients (120 knees) were operated between September 2009 and 2011 (age 68±9 years) using the cementless Hyperflex version of the Natural Knees (Zimmer, Warsaw, IN, USA). Postero stabilization was achieved using deep-dished inserts. The Gender configuration has provided narrow inserts to better adapt the female anatomy. A special navigation system measured the displacement of the lateral and medial femoro-tibial contact points with infra-millimetric precision. Adopting a tibial cut first, gap-balancing technique with anterior referencing, the decision to oversize the femoral component relied on the 90° flexion drawer test, which showed more than 6mm sagittal laxity before the femoral bone cuts. Eighty-one (105 knees) patients were reviewed with average 63±27-month follow-up. RESULTS: Femoral components were augmented by 1 size in 60 cases and by 2 sizes in 7 cases. At final review, knees with an oversized femoral component (60) achieved the same results as those implanted with a non-oversized femoral component (n=45) in terms of mean flexion gain (-5°±34 versus -4°±23, p=0.78), mean FJS (63±26 versus 61±23; p=0.56). CONCLUSION: Balancing the Flexion gap by oversizing the femoral component did not compromise flexion range and functional results. LEVEL OF EVIDENCE: IV, Retrospective cohort study.
Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Ajuste de Prótese/métodos , Amplitude de Movimento Articular , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/cirurgia , Condrocalcinose/cirurgia , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia/cirurgia , Resultado do Tratamento , Tuberculose Osteoarticular/cirurgiaRESUMO
BACKGROUND: The association between the synovial chondromatosis (SC) and the calcium pyrophosphate deposition (pseudogotta) in temporomandibular joint (TMJ) is very rare and has been described just 1 patient in the literature. CLINICAL PRESENTATION: A 64-year-old woman was referred to Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, Sapienza Università di Roma after complaining about right temporomandibular pain, limitation in mandibular movements, and tumefaction in the right preauricular region. The patient was hospitalized for the surgery. The microscopic examination of the excised material revealed calcium pyrophosphate dihydrate (CPPD) deposits crystals associated with cartilaginous proliferation. CONCLUSION: The association between the SC and the calcium pyrophosphate deposition (pseudogotta) is a challenging diagnosis among TMJ neoplasms.
Assuntos
Pirofosfato de Cálcio , Condrocalcinose/diagnóstico , Condromatose Sinovial/diagnóstico , Transtornos da Articulação Temporomandibular/etiologia , Condrocalcinose/complicações , Condrocalcinose/cirurgia , Condromatose Sinovial/complicações , Condromatose Sinovial/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos da Articulação Temporomandibular/cirurgiaRESUMO
Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid hand arthropathies is beneficial for clinicians to recognize these problems.
Assuntos
Artrite/fisiopatologia , Articulação da Mão/fisiopatologia , Artrite/cirurgia , Artroplastia , Artroscopia , Condrocalcinose/fisiopatologia , Condrocalcinose/cirurgia , Complicações do Diabetes/fisiopatologia , Complicações do Diabetes/cirurgia , Gota/fisiopatologia , Gota/cirurgia , Articulação da Mão/cirurgia , Hemocromatose/fisiopatologia , Hemocromatose/cirurgia , Hepatite C Crônica/fisiopatologia , Hepatite C Crônica/cirurgia , HumanosRESUMO
BACKGROUND: Glenohumeral exploration is routinely performed during arthroscopic removal of rotator cuff calcifications in patients with calcific tendinitis of the shoulder (CTS). However, evidence on the prevalence of intraarticular co-pathologies is lacking and the benefit of glenohumeral exploration remains elusive. The aim of the present study was to assess and quantify intraoperative pathologies during arthroscopic removal of rotator cuff calcifications in order to determine whether standardized diagnostic glenohumeral exploration appears justified in CTS patients. METHODS: One hundred forty five patients undergoing arthroscopic removal of calcific depots (CD) that failed conservative treatment were included in a retrospective cohort study. Radiographic parameters including number/localization of calcifications and acromial types, intraoperative arthroscopic findings such as configuration of glenohumeral ligaments, articular cartilage injuries, and characteristics of calcifications and sonographic parameters (characteristics/localization of calcification) were recorded. RESULTS: One hundred forty five patients were analyzed. All CDs were removed by elimination with a blunt hook probe via "squeeze-and-stir-technique" assessed postoperatively via conventional X-rays. Neither subacromial decompression nor refixation of the rotator cuff were performed in any patient. Prevalence of glenohumeral co-pathologies, such as partial tears of the proximal biceps tendon (2.1%), superior labral tears from anterior to posterior (SLAP) lesions (1.4%), and/or partial rotator cuff tears (0.7%) was low. Most frequently, glenohumeral articular cartilage was either entirely intact (ICRS grade 0 (humeral head/glenoid): 46%/48%) or showed very mild degenerative changes (ICRS grade 1: 30%/26%). Two patients (1.3%) required intraarticular surgical treatment due to a SLAP lesion type III (n = 1) and an intraarticular rupture of CD (n = 1). CONCLUSIONS: Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of CTS due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. Exploration of the glenohumeral joint in arthroscopic removal of CD should only be performed in case of founded suspicion of relevant concomitant intraarticular pathologies.
Assuntos
Condrocalcinose/cirurgia , Ligamentos Articulares/patologia , Manguito Rotador/patologia , Articulação do Ombro/patologia , Tendinopatia/cirurgia , Adulto , Idoso , Artroscopia/métodos , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/epidemiologia , Condrocalcinose/patologia , Feminino , Humanos , Período Intraoperatório , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prevalência , Radiografia , Estudos Retrospectivos , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Tendinopatia/epidemiologia , Tendinopatia/patologia , UltrassonografiaRESUMO
BACKGROUND: Operative treatment of chondrocalcinosis (calcium pyrophosphate dihydrate deposition disease=CPPD disease) of the wrist is hardly ever mentioned in the literature. Since the chronic, recurrent type of this disease resembles rheumatoid arthritis (RA) as well as osteoarthritis, the author has performed arthroscopic synovectomy of the wrist, which achieves excellent results in RA und offers high patient comfort as an atraumatic procedure with low morbidity. This article presents the experience made with arthroscopic synovectomy in CPPD disease of the wrist. PATIENTS AND METHODS: Out of 74 arthroscopic synovectomies in 71 patients with symptomatic CPPD disease of the wrist, 46 operations in 43 patients were followed for an average of 26.6 months after surgery. 15 women and 28 men at an average age of 64.5 (42-90) years had a telephone interview and were asked for pain, functional impairment and satisfaction with the intervention. Intraoperative and histologic findings were recorded. According to the Romano Classification, there was SCAC (scaphoid chondrocalcinosis advanced collapse) I in 6 cases (13%), SCAC II in 18 (39%), SCAC III in 9 (19.5%) and SCAC IV in 3 cases (6.5%). In 10 X-rays, classification according to Romano was not possible. RESULTS: There was a significant reduction in pain at rest and on weight-bearing as well as a significant improvement in hand function. 74% of patients would chose to undergo the intervention again. Arthroscopy revealed the typical symptoms of CPPD disease in all cases. In 38 out of the 46 operations, a histologic examination was performed and was positive in 20 cases. CONCLUSIONS: Arthroscopic synovectomy of the wrist in patients with CPPD disease provides high patient satisfaction regardless of the radiologic stage. The procedure is atraumatic with low morbidity and high patient comfort. The Romano Classification should be supplemented by an additional early stage, SCAC 0. More often than suspected, CPPD disease may be responsible for wrist pain of unknown origin even in middle-aged patients.
Assuntos
Condrocalcinose/cirurgia , Sinovectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suporte de Carga , Punho , Articulação do PunhoRESUMO
BACKGROUND: Calcification of the yellow ligament sometimes compresses the spinal cord and can induce myelopathy. Usually, the calcification does not induce acute neck pain. We report a case of a patient with acute neck pain caused by calcium pyrophosphate dihydrate in a calcified cervical yellow ligament. CASE PRESENTATION: A 70-year-old Japanese woman presented with acute neck pain. She had a moderately high fever (37.5 °C), and her neck pain was so severe that she could not move her neck in any direction. Computed tomography showed a high-density area between the C5 and C6 laminae suspicious for calcification of the yellow ligament. Magnetic resonance imaging showed intermediate-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging surrounding a low-signal region on both T1- and T2-weighted imaging with cord compression. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament. CONCLUSIONS: Pseudogout attack of the cervical yellow ligament is rare, but this clinical entity should be added to the differential diagnosis of acute neck pain, especially when calcification of the yellow ligament exists.
Assuntos
Calcinose/diagnóstico por imagem , Pirofosfato de Cálcio , Condrocalcinose/diagnóstico por imagem , Ligamento Amarelo/diagnóstico por imagem , Cervicalgia/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Dor Aguda , Idoso , Calcinose/complicações , Calcinose/cirurgia , Vértebras Cervicais , Condrocalcinose/complicações , Condrocalcinose/cirurgia , Feminino , Humanos , Ligamento Amarelo/cirurgia , Imageamento por Ressonância Magnética , Cervicalgia/etiologia , Cervicalgia/cirurgia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
CASE: A 55-year-old man presented with a history of forefoot pain and swelling. Radiographs revealed a mass with internal calcifications and osseous erosion of the fifth metatarsophalangeal bone. The mass was isointense to muscle on T1-weighted magnetic resonance imaging (MRI) and hyperintense on T2-weighted MRI. A biopsy was performed, and intraoperatively, the lesion appeared as chalky white material, which under polarized light microscopy was composed of weakly positively birefringent rhomboid crystals, leading to a diagnosis of tophaceous pseudogout. CONCLUSION: Tophaceus pseudogout should be included in the differential diagnosis of neoplastic-appearing lesions in the foot, and polarized light microscopy should be used when examining biopsy specimens.
Assuntos
Condrocalcinose/diagnóstico , Antepé Humano/diagnóstico por imagem , Condrocalcinose/patologia , Condrocalcinose/cirurgia , Diagnóstico Diferencial , Antepé Humano/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors present a case of a 60-year-old woman with a destructive painful condition in the right temporomandibular joint (TMJ) that proved to be calcium pyrophosphate crystal deposits at subsequent biopsy examination. The patient presented with the chief complaints of pain and limitation that had not resolved with splint therapy, medications, and habit control. Magnetic resonance imaging studies showed internal derangement without reduction. Right TMJ arthroscopy with manipulation of the jaw under anesthesia showed unique findings of fronds of synovial tissue in the posterior joint space and areas of white matter. Because there was no long-term improvement in her clinical symptoms, she subsequently underwent arthroplasty of the right joint, with the white material clearly seen at surgery, and the biopsy examination confirmed the clinical and arthroscopic impression of pseudogout. The presentation, diagnosis, pathology, and treatment of pseudogout of the TMJ are discussed.
Assuntos
Condrocalcinose/diagnóstico , Transtornos da Articulação Temporomandibular/diagnóstico , Artroplastia/métodos , Artroscopia/métodos , Biópsia/métodos , Condrocalcinose/cirurgia , Diagnóstico Diferencial , Fáscia/transplante , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Côndilo Mandibular/patologia , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Retalhos Cirúrgicos/transplante , Líquido Sinovial , Membrana Sinovial/patologia , Músculo Temporal/transplante , Disco da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Tomografia Computadorizada por Raios X/métodosAssuntos
Condrocalcinose/diagnóstico por imagem , Drenagem/métodos , Abscesso do Psoas/diagnóstico por imagem , Músculos Psoas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Condrocalcinose/complicações , Condrocalcinose/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Abscesso do Psoas/etiologia , Abscesso do Psoas/cirurgiaRESUMO
OBJECTIVE: We report a series of 3 cases of tophaceous pseudogout of the temporomandibular joint (TMJ). STUDY DESIGN: Three patients, two men and one woman, ranging in age between 60 and 75 years, presented with unilateral painful swelling of the TMJ area associated with limitation of mouth opening. RESULTS: Radiographic and computed tomographic images showed opaque masses in the supracondylar region of the TMJ. The preoperative clinical impression was a "neoplastic lesion" in the 3 cases. Microscopic examination revealed numerous deeply basophilic masses of calcified deposits, exhibiting birefringence under polarized light and morphologically consistent with calcium pyrophosphate dihydrate deposition, referred to in these cases as "tophaceous pseudogout." CONCLUSION: Tophaceous pseudogout is a rare benign arthropathy that presents with clinical and radiographic features mimicking neoplastic conditions of the TMJ. Therefore, it is recommended that tophaceous pseudogout be considered in the differential diagnosis when a TMJ is involved with "neoplasm-like" lesions clinically and radiographically.
Assuntos
Condrocalcinose/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Idoso , Fosfatos de Cálcio , Condrocalcinose/patologia , Condrocalcinose/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Panorâmica , Transtornos da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Chondrocalcinosis is manifested by crystalline deposits of calcium commonly found during primary TKA for osteoarthritis. Its frequency among patients undergoing TKA is poorly defined, as is its influence on pain or function after TKA. QUESTIONS/PURPOSES: The purposes of this study are to (1) determine the prevalence of chondrocalcinosis in patients undergoing TKA for osteoarthritis; (2) evaluate the effect of chondrocalcinosis on ROM and The Knee Society scores; (3) determine if patients with chondrocalcinosis and severe synovitis who underwent synovectomy are at risk for lower postoperative Knee Society scores and less ROM; and (4) assess if chondrocalcinosis is associated with increased rates of revision surgery. METHODS: We retrospectively reviewed the medical records of 1500 primary TKAs performed by one surgeon. The minimum followup for patients was 24 months (average, 57 months; range, 24-120 months). There were 511 men and 934 women with an average age of 70 years. Fifty-five patients underwent bilateral knee replacements. Crystal deposition was graded prospectively during surgery using a subjective visual scale. A thorough synovectomy was performed on patients with severe synovitis and apparent crystalline deposition suggestive of calcium pyrophosphate dihydrate (CPPD) deposition (n = 50). The Knee Society scores, ROM, and revision rates were compared between patients with visible chondrocalcinosis with those without and between patients with mild chondrocalcinosis with those with severe chondrocalcinosis. RESULTS: Chondrocalcinosis was found in 173 male patients (34%) undergoing TKAs during this period compared with 224 female patients (24%) (p < 0.001). The Knee Society scores for knee rating and function were similar in patients with or without chondrocalcinosis undergoing TKA. However, patients with visible CPPD deposition who underwent synovectomy for proliferative synovitis had diminished final ROM and Knee Society knee rating scores (107(o) versus 115(o) knee flexion, p < 0.001 and 87 versus 94 points, p = 0.001). We cannot determine whether this result is because of the synovectomy or severity of the disease, and therefore we cannot recommend a synovectomy at this time. Revision rates were no different among patients with chondrocalcinosis compared with those without it (3.6% versus 2.2%, p = 0.2). CONCLUSIONS: Chondrocalcinosis is common among patients undergoing TKA for osteoarthritis. The presence of CPPD deposition does not appear to affect the ROM and Knee Society scores of patients with CPPD but without severe synovitis. However, patients with severe synovitis and visible CPPD who underwent thorough synovectomy may be at risk for having decreased postoperative ROM and pain develop. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.