Silicone synovitis: longer term outcome data and review of the literature.
BACKGROUND
Silicone had been popular for small and medium joint prostheses from the 1960s until the 1980s when concerns about subsequent arthritis arose. There are still patients with long-standing silicone prostheses. We describe 7 cases of synovitis attributed to these.


METHODS
This is a case series of patients having synovitis in the vicinity of a silicone arthroplasty. The diagnosis was determined by examination and, radiographic and operative characteristics of the joint. Underlying diseases of the patients, treatment strategies, and responses to treatment were reviewed.


RESULTS
Seven charts were reviewed. The ages ranged from 53 to 90 years (mean = 71.5). Two patients had osteoarthritis, 1 had rheumatoid arthritis, 3 had trauma, and 1 had avascular necrosis. Joints included 2 metatarsal phalangeal, 3 carpal bones, 1 radial head, and 2 first carpal metacarpals. The time from arthroplasty to synovitis was 9 to 30 years (mean = 16). Five patients had surgical management and 2 had medical management. Four of the surgically managed patients had resolution of their symptoms, 1 had a recurrent synovitis requiring further surgery. One person had 2 arthroplasties, but developed synovitis at only 1 site. The 2 patients medically managed continued to have synovitis.


CONCLUSIONS
Synovitis continues to be a consequence of silicone arthroplasty. It can be a late complication with our shortest time to synovitis being 9 years. Underlying pathology does not seem to predict the synovitis as patients with osteoarthritis, rheumatoid arthritis, avascular necrosis, and trauma are all represented. Surgically managed patients did well, whereas patients managed medically did not have resolution of their symptoms.
Pugliese
David
D
Department of Rheumatology, Geisinger Medical Center, Danville, PA, USA. dmpugliese@geisinger.edu
Bush
David
D
Harrington
Thomas
T
D000368:Aged; D000369:Aged, 80 and over; D001133:Bones of Upper Extremity; D015331:Cohort Studies; D005549:Foreign-Body Reaction / Q000209:etiology*; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation; D012826:Silicone Elastomers / Q000009:adverse effects; D013585:Synovitis / Q000209:etiology*
D012826:Silicone Elastomers