Follow-up results of arthroscopic synovectomy for the rheumatoid knee

Abstract

Arthroscopic synovectomy (ASS) of a rheumatoid knee is performed in cases of intractable synovitis. This spares the articular cartilage, and is an effective and simple treatment for chronic knee synovitis. This retrospective study was performed to evaluate the outcome of surgical arthroscopy, and study the clinical results in detail. A total of 160 knees, in 138 patients, were assessed after a mean follow-up of 35 months. There was a statistically significant improvement in pain, synovitis, and walking ability for at least 24 months after surgery. Based on the results of our study, age, duration of rheumatoid arthritis (RA), and erythrocyte sedimentation rate (ESR) and level of C-reactive protein (CRP) at surgery were not predictors of a poor long-term outcome of ASS. However, the clinical results correlated with the Lansbury index, loss of extension of the knee joint, a modified Larsen score, and the Larsen grade of the knee joint. Of the cases studied, total knee arthroplasty (TKA) was performed in 29 knee joints. We concluded that although ASS can reduce local inflammation and delay the need for definitive replacement surgery, patients over 60 years of age who show severe radiographic changes should undergo primary TKA.

Treatment for chronic synovitis of knee: arthroscopic or open synovectomy

“…Many studies have demonstrated that synovectomy can effectively relieve the symptom and improve the function of the affected joints because of removing actively inflamed synovium [1][2][3][4]. Open synovectomy is the traditional effective surgery in treating chronic synovitis.…”

Arthroscopic synovectomy of the knee in rheumatoid arthritis defined by the 2010 ACR/EULAR criteria

“…Although the surgical technique described in this paper is similar to other studies, the definition of RA widely varies among the different papers [10][11][12][13][14][15][16][17][18][19], and the most common flaws include: (1) heterogeneous groups of patients (RA, psoriatic arthritis, pigmented villonodular synovitis, chondromatosis, non-specific, seronegative, and posttraumatic synovitis); (2) no clear definition of RA; and (3) the use of the ACR 1987 criteria for RA [20].…”

“…Although open synovectomy is still a valuable option for the treatment of rheumatoid patients, arthroscopic synovectomy is becoming popular for many large joints, including shoulder [5], elbow [6], wrist [7], hip [8], knee [2] and ankle [9]. Arthroscopic synovectomy of the knee in RA is a relatively common procedure and different studies report good outcomes [10][11][12][13][14][15][16][17][18][19]. However, most of the papers available in the literature that include heterogeneous groups of patients (grouping RA, psoriatic arthritis, pigmented villonodular synovitis, chondromatosis, non-specific, seronegative, and post-traumatic synovitis), do not specify the diagnostic criteria for RA, or use the American College of Rheumatology (ACR) 1987 criteria [20].…”

Long-term results of open elbow synovectomy for rheumatoid arthritis

“…The advantages of arthroscopic synovectomy over open synovectomy have long been recognized in the knee, with patients experiencing less pain postoperatively, an earlier return of motion, and an overall quicker recovery. 9 Arthroscopic synovectomy in the elbow, however, is technically more demanding as the neurovascular structures are closer to the operative fi eld and require special consideration. 10 Some investigators have reported the risk of damaging neurovascular structures, such as the ulnar nerve, radial nerve, and brachial artery.…”

“…Moreover, suitability of this procedure for cases with advanced-stage RA and sequential time-dependent longterm results have not been clearly explained. In terms of the surgical approach, arthroscopic synovectomy is an area of growing interest, 9 while open procedure has been the surgical procedure of choice at our institution to date. The advantages of arthroscopic synovectomy over open synovectomy have long been recognized in the knee, with patients experiencing less pain postoperatively, an earlier return of motion, and an overall quicker recovery.…”