Management of knee arthropathy in patients with vascular malformations

Jonathan N. Johnson, William J. Shaughnessy, Anthony A. Stans, Kenneth P. Unruh, Franklin H. Sim, Amy L. McIntosh, Chad K. Brands, David J. Driscoll

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVE: To describe our experience with surgical intervention for symptomatic intraarticular vascular malformations of the knee in patients with peripheral vascular malformations including Klippel-Trénaunay syndrome (KTS). METHODS: Eleven patients underwent surgical intervention for symptomatic intraarticular vascular malformations of the knee between 1987 and 2008. Seven patients had KTS, and 4 patients had venous malformations. Surgical indications, imaging studies, clinical course, surgical procedures, complications, and follow-up visits were reviewed and recorded. RESULTS: A total of 11 patients (8 males; 3 females; mean age, 11.7 years; range, 2.5-23 years) underwent 12 surgical procedures. Five patients had an amputation, and 6 patients had knee synovectomies. One patient had bilateral knee synovectomies. Surgical indications included pain, swelling, limited mobility, and/or loss of knee motion. The average time of follow-up was 54 months (range, 7-109 months). Patient-reported pain scores decreased significantly from a mean of 2.9 ± 1.4 preoperatively to 1.3 ± 0.9 postoperatively (P = 0.01). CONCLUSIONS: When necessary, surgical intervention for intraarticular vascular malformations of the knee (amputation or synovectomy) may be effective in decreasing pain and improving mobility in patients with peripheral vascular malformations. It is possible that early synovectomy may slow or prevent the rapid destructive arthritis that occurs in these knees. Surgeons and patients should anticipate complications related to bleeding from vascular malformations. We recommend a multidisciplinary approach to the patient with KTS, particularly when surgical intervention is indicated.

Original languageEnglish (US)
Pages (from-to)380-384
Number of pages5
JournalJournal of Pediatric Orthopaedics
Volume29
Issue number4
DOIs
StatePublished - Jun 2009

Fingerprint

Vascular Malformations
Joint Diseases
Knee
Amputation
Pain
Arthritis

Keywords

  • Amputation
  • Disarticulation
  • Klippel-Trénaunay syndrome
  • Knee arthropathy
  • Synovectomy
  • Venous malformation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Johnson, J. N., Shaughnessy, W. J., Stans, A. A., Unruh, K. P., Sim, F. H., McIntosh, A. L., ... Driscoll, D. J. (2009). Management of knee arthropathy in patients with vascular malformations. Journal of Pediatric Orthopaedics, 29(4), 380-384. https://doi.org/10.1097/BPO.0b013e3181a5b0b3

Management of knee arthropathy in patients with vascular malformations. / Johnson, Jonathan N.; Shaughnessy, William J.; Stans, Anthony A.; Unruh, Kenneth P.; Sim, Franklin H.; McIntosh, Amy L.; Brands, Chad K.; Driscoll, David J.

In: Journal of Pediatric Orthopaedics, Vol. 29, No. 4, 06.2009, p. 380-384.

Research output: Contribution to journalArticle

Johnson, JN, Shaughnessy, WJ, Stans, AA, Unruh, KP, Sim, FH, McIntosh, AL, Brands, CK & Driscoll, DJ 2009, 'Management of knee arthropathy in patients with vascular malformations', Journal of Pediatric Orthopaedics, vol. 29, no. 4, pp. 380-384. https://doi.org/10.1097/BPO.0b013e3181a5b0b3
Johnson, Jonathan N. ; Shaughnessy, William J. ; Stans, Anthony A. ; Unruh, Kenneth P. ; Sim, Franklin H. ; McIntosh, Amy L. ; Brands, Chad K. ; Driscoll, David J. / Management of knee arthropathy in patients with vascular malformations. In: Journal of Pediatric Orthopaedics. 2009 ; Vol. 29, No. 4. pp. 380-384.
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abstract = "OBJECTIVE: To describe our experience with surgical intervention for symptomatic intraarticular vascular malformations of the knee in patients with peripheral vascular malformations including Klippel-Tr{\'e}naunay syndrome (KTS). METHODS: Eleven patients underwent surgical intervention for symptomatic intraarticular vascular malformations of the knee between 1987 and 2008. Seven patients had KTS, and 4 patients had venous malformations. Surgical indications, imaging studies, clinical course, surgical procedures, complications, and follow-up visits were reviewed and recorded. RESULTS: A total of 11 patients (8 males; 3 females; mean age, 11.7 years; range, 2.5-23 years) underwent 12 surgical procedures. Five patients had an amputation, and 6 patients had knee synovectomies. One patient had bilateral knee synovectomies. Surgical indications included pain, swelling, limited mobility, and/or loss of knee motion. The average time of follow-up was 54 months (range, 7-109 months). Patient-reported pain scores decreased significantly from a mean of 2.9 ± 1.4 preoperatively to 1.3 ± 0.9 postoperatively (P = 0.01). CONCLUSIONS: When necessary, surgical intervention for intraarticular vascular malformations of the knee (amputation or synovectomy) may be effective in decreasing pain and improving mobility in patients with peripheral vascular malformations. It is possible that early synovectomy may slow or prevent the rapid destructive arthritis that occurs in these knees. Surgeons and patients should anticipate complications related to bleeding from vascular malformations. We recommend a multidisciplinary approach to the patient with KTS, particularly when surgical intervention is indicated.",
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AU - Johnson, Jonathan N.

AU - Shaughnessy, William J.

AU - Stans, Anthony A.

AU - Unruh, Kenneth P.

AU - Sim, Franklin H.

AU - McIntosh, Amy L.

AU - Brands, Chad K.

AU - Driscoll, David J.

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N2 - OBJECTIVE: To describe our experience with surgical intervention for symptomatic intraarticular vascular malformations of the knee in patients with peripheral vascular malformations including Klippel-Trénaunay syndrome (KTS). METHODS: Eleven patients underwent surgical intervention for symptomatic intraarticular vascular malformations of the knee between 1987 and 2008. Seven patients had KTS, and 4 patients had venous malformations. Surgical indications, imaging studies, clinical course, surgical procedures, complications, and follow-up visits were reviewed and recorded. RESULTS: A total of 11 patients (8 males; 3 females; mean age, 11.7 years; range, 2.5-23 years) underwent 12 surgical procedures. Five patients had an amputation, and 6 patients had knee synovectomies. One patient had bilateral knee synovectomies. Surgical indications included pain, swelling, limited mobility, and/or loss of knee motion. The average time of follow-up was 54 months (range, 7-109 months). Patient-reported pain scores decreased significantly from a mean of 2.9 ± 1.4 preoperatively to 1.3 ± 0.9 postoperatively (P = 0.01). CONCLUSIONS: When necessary, surgical intervention for intraarticular vascular malformations of the knee (amputation or synovectomy) may be effective in decreasing pain and improving mobility in patients with peripheral vascular malformations. It is possible that early synovectomy may slow or prevent the rapid destructive arthritis that occurs in these knees. Surgeons and patients should anticipate complications related to bleeding from vascular malformations. We recommend a multidisciplinary approach to the patient with KTS, particularly when surgical intervention is indicated.

AB - OBJECTIVE: To describe our experience with surgical intervention for symptomatic intraarticular vascular malformations of the knee in patients with peripheral vascular malformations including Klippel-Trénaunay syndrome (KTS). METHODS: Eleven patients underwent surgical intervention for symptomatic intraarticular vascular malformations of the knee between 1987 and 2008. Seven patients had KTS, and 4 patients had venous malformations. Surgical indications, imaging studies, clinical course, surgical procedures, complications, and follow-up visits were reviewed and recorded. RESULTS: A total of 11 patients (8 males; 3 females; mean age, 11.7 years; range, 2.5-23 years) underwent 12 surgical procedures. Five patients had an amputation, and 6 patients had knee synovectomies. One patient had bilateral knee synovectomies. Surgical indications included pain, swelling, limited mobility, and/or loss of knee motion. The average time of follow-up was 54 months (range, 7-109 months). Patient-reported pain scores decreased significantly from a mean of 2.9 ± 1.4 preoperatively to 1.3 ± 0.9 postoperatively (P = 0.01). CONCLUSIONS: When necessary, surgical intervention for intraarticular vascular malformations of the knee (amputation or synovectomy) may be effective in decreasing pain and improving mobility in patients with peripheral vascular malformations. It is possible that early synovectomy may slow or prevent the rapid destructive arthritis that occurs in these knees. Surgeons and patients should anticipate complications related to bleeding from vascular malformations. We recommend a multidisciplinary approach to the patient with KTS, particularly when surgical intervention is indicated.

KW - Amputation

KW - Disarticulation

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KW - Knee arthropathy

KW - Synovectomy

KW - Venous malformation

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