Incisionless Synovium and Bone Biopsy of a Painful Total Knee Arthroplasty

Autor: Syed Ali Sina Adil, Ali Oliashirazi, Tyag Patel, Matthew Bullock, Chad Lavender
Rok vydání: 2021
Předmět:
Zdroj: Arthroscopy Techniques, Vol 10, Iss 2, Pp e475-e479 (2021)
Arthroscopy Techniques
ISSN: 2212-6287
DOI: 10.1016/j.eats.2020.10.022
Popis: Knee arthroscopy has evolved greatly from its inception in the 20th century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We continue to develop more minimally invasive procedures, and the NanoScope (Arthrex, Naples, FL) has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and using the GraftNet (Arthrex), we can harvest tissue with a standard shaver for further evaluation. This technique provides an option to perform a synovial and bone biopsy in a painful total knee arthroplasty without the use of standard arthroscopy portals through an incisionless approach. This technique provides distinct advantages over a more open approach in the setting of a prosthetic joint. Specifically, this technique is useful for a difficult-to-diagnose painful total knee arthroplasty.
Technique Video Video 1 Incisionless synovial and bone biopsy technique. A spinal needle is inserted into the superolateral joint space while the left knee is in full extension. A nitinol wire is inserted into the needle, and the needle is removed. A high-flow 3.4-mm cannula is then inserted over the wire, and the wire is removed. Care should be taken when inserting the 3.4-mm cannula because it can cause damage during insertion. Inflow is then placed onto the cannula, and the NanoScope is inserted for visualization of the joint. A standard diagnostic arthroscopy is performed in the patellofemoral joint. The other portals will be established in the anterolateral joint space and anteromedial joint space and in a similar fashion, with the knee in flexion. Next, with the NanoScope through the superolateral portal and the left knee in extension, the patellofemoral synovium is examined and found to be hypertrophic, hyper-vascularized, and inflamed. Then, we place the NanoScope through the anterolateral joint space through the high-flow cannula, and the patellofemoral joint is viewed and examined. Viewing through the anterolateral joint space with the knee in extension, we place a shaver through the superolateral joint space. The GraftNet is attached to the shaver, and as shown, synovial biopsy specimens are obtained. Care is taken to obtain samples from the medial aspect, lateral aspect, and superior aspect. Next, a shaver with the GraftNet is placed through the anteromedial portal, and further biopsy specimens can be obtained. The left knee is then brought into flexion, and after use of the anteromedial portal as the working portal, the shaver is placed through the anterolateral portal and the anterior synovium is biopsied. Care is taken to view the tibia-cement interface and anterior compartment. With the NanoScope placed through the anterolateral portal and the shaver placed through the superolateral portal, areas on the lateral bone interface and anterior flange–bone interface are shaved down to bone. Then, the GraftNet is applied to the shaver, and as shown, the bone biopsy specimens are obtained. First, we take a biopsy specimen from the lateral femur; then, the anterior bone is biopsied. Care must be taken not to resect too much bone.
Databáze: OpenAIRE
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