Journal of

Case Reports and Images in Orthopedics and Rheumatology

 
     
Case Report
 
Inflammatory pseudoseptic reaction to Synvisc-One® injection requiring diagnostic arthroscopy
Richard Danilkowicz1, Matthew Robinson1, Matthew Steffes1, Matthew Marcus1
1University of Illinois at Chicago College of Medicine, Department of Orthopaedics, Chicago, Illinois, USA

Article ID: 100005Z14RD2017
doi:10.5348/Z14-2017-5-CR-2

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Richard Danilkowicz
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How to cite this article:
Danilkowicz R, Robinson M, Steffes M, Marcus M. Inflammatory pseudoseptic reaction to Synvisc-One® injection requiring diagnostic arthroscopy. J Case Rep Images Orthop Rheum 2017;2:7–11.


ABSTRACT
Introduction: Local and inflammatory reactions to hylan G-F 20 (Synvisc-One®) injections are a common occurrence generally controlled with non-steroidal anti-inflammatory medications and steroid injections. When reactions persist despite conservative measures, there is little literature on escalation of treatment. This case outlines the first instance of hylan G-F 20 induced pseudo-sepsis requiring diagnostic arthroscopy to our knowledge.
Case Report: A 41-year-old female with a 10-year history of bilateral knee pain developed a unilateral local inflammatory reaction after receiving a second course of Synvisc-One® treatments. Arthrocentesis was performed twice after the reaction and was non-diagnostic each time. The patient continued to complain of pain after failing conservative therapy consisting of oral medications and physical therapy. A diagnostic arthroscopy was then performed that was significant for outerbridge grade 3 changes observed on the medial femoral condyle and lateral femoral condyle as well as fraying about the edges of the lateral meniscus with a small radial tear. The patient reported a subjective decrease in knee pain postoperatively, which returned shortly after. On four-month follow-up, the patient continued to experience pain despite negative physical exam findings and has been referred to a pain clinic for further treatment.
Conclusion This case outlines the first instance of hylan G-F 20 induced pseudo-sepsis requiring diagnostic arthroscopy to our knowledge. This instance highlights a unique treatment approach to a relatively common event in order to potentially guide treatment decisions in future cases.


Keywords: Arthroscopy, Inflammation, Pseudosepsis, Synvisc-One® injection


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Author Contributions
Richard Danilkowicz – Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Matthew Robinson – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Matthew Steffes – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Matthew Marcus – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Richard Danilkowicz et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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