Clinical History:
Two separate patients complaining of wrist pain without recent trauma.
Figure 1a |
Figure 1b |
Figure 1c |
Radiographic Findings:
Plain film radiographs of each patient (Figures 1a and 2) show joint space
narrowing with destructive, erosive, and cystic changes involving the carpal
joint spaces predominately. In addition, there is radio-opaque material
in the expected location of the lunate bone in Figure 1a, confirmed at CT
(Figure 1b), and at the base of the first metacarpal in Figure 2.
Discussion:
Silicone synovitis (SS) is caused by silicone microparticles that incite
a giant-cell inflammatory reaction within the joint leading to bony erosions
and lytic lesions. Originally silicone implant arthroplasty showed great
promise for patients in non-weight bearing joints with bony abnormalities
such as avascular necrosis or osteoarthritis. Patients who had disabling
pain preoperatively became pain-free shortly after the arthroplasty procedures.
However, it became apparent that many patients returned complaining of
worsening joint pain, swelling, weakness, and clicking at the surgical
site.
Studies have reported a wide variation in both the postoperative times
for symptoms (3-132 months) as well as the percentage of patients developing
SS (4.8% - 90%). The use of silicone implants for arthroplasty has been
discontinued and cases of this entity become rare with time. The clinical
history and presence of the slightly opaque silicone implants help to
make the appropriate diagnosis. Fortunately, the symptoms tend to resolve
after the implants are removed.
Diagnosis:
Silicone Synovitis
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