Orthopedic management of a patient with pigmented villonodular synovitis.

ABSTRACT: Pigmented villonodular synovitis (PVNS), sometimes also called tenosynovial giant cell tumor, is a rare, slow-growing, benign soft-tissue disorder. PVNS most commonly affects the knee and is associated with painful hemarthrosis and joint swelling. The condition also can affect the hip, ankle, shoulder, or elbow. This article reviews practice guidelines for PVNS, diagnosis, and surgical and nonsurgical treatments.

Accuracy of computer-navigated total hip arthroplasty.

Proper acetabular cup orientation is essential in total hip arthroplasty. The purpose of this study was to evaluate the accuracy of a particular imageless computer navigation system in determining cup position. Thirty-nine computer-navigated total hip arthroplasty intraoperative measurements of cup abduction and anteversion were compared with those from follow-up radiographs. Sensitivity, specificity, accuracy, prevalence-adjusted positive value (PPV), and negative predictive value were calculated for both navigation and radiographs. Navigation measurements had high specificity and PPV when assessing cup abduction and anteversion (specificity >90%, PPV >94%). In contrast, the system was not very effective in detecting suboptimal cup position (sensitivity abduction, 50%; anteversion, 33%). Intraoperative navigation readings in the safe zone have high probability of indicating correct placement. However, confirmation of suboptimal cup position intraoperatively requires additional diagnostic methods.

Tendinopathy of the long head of the biceps.

Tendinopathy of the long head of the biceps is a common cause of anterior shoulder pain. As such, the anatomy and function of the tendon as well as its pathophysiology and different treatment methods have been studied extensively. The pathophysiology is a spectrum beginning with inflammation and leading to tendon degeneration. Different clinical tests and imaging modalities may all be employed to help aid in diagnosis. Conservative management is the first-line treatment, but surgical intervention may be warranted. In general, tenotomy or tenodesis is performed depending, among other things, on the age and activity level of the patient. There are several different methods for tenodesis, each with certain advantages and disadvantages. Patient factors must be considered when choosing the optimal treatment.