Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Abstract

Background During primary total knee arthroplasty (TKA), synovectomy as a part of the procedure has been recommended to relieve pain and inflammation of the synovium, but there is a controversy about it due to increased bleeding. In this meta-analysis, the aim is to answer whether synovectomy should be performed routinely during TKA for symptomatic knee osteoarthritis (KOA). Methods Relevant randomized controlled trials (RCTs) on synovectomy were retrieved through database searches of PubMed, Embase, Web of Science, and Cochrane Library up to February 2019. Studies that compared postoperative pain, clinical Knee Society Score (KSS), functional KSS, range of motion (ROM), drainage, pre- and postoperative hemoglobin difference, transfusion rate, operative time, and/or complications were included in the meta-analysis. Review Manager 5.3.0 was used for meta-analysis. Results We included 5 RCTs with 542 knees. Pooled results indicated that the synovectomy group was associated with more blood loss via drainage (WMD = − 99.41, 95% CI − 153.75 to − 45.08, P = 0.0003) and pre- and postoperative hemoglobin difference (WMD = − 0.93, 95% CI − 1.33 to − 0.5, P < 0.00001), compared with the non-synovectomy group. No statistically significant differences were demonstrated between both groups in postoperative pain, clinical KSS, functional KSS, ROM, transfusion rate, or complications ( P > 0.05). Conclusions The current evidence demonstrates that performing synovectomy in primary TKA for symptomatic KOA does not have any clinical benefit. It increases postsurgical blood loss. Surgeons routinely undertaking synovectomy should deliberate whether this is clinically indicated and consider limiting resection, if possible.

Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial

“…[ 5 – 8 , 12 ] A meta-analysis based on the previous clinical trials has demonstrated that conducting synovectomy in primary TKA for patients with OA does not relieve pain during 1-year follow-up period. [ 14 , 22 ] It was demonstrated in our study that excision or retention of synovium has little effect on postoperative pain post-TKA during a 10-year follow-up period. In addition, based on our findings, the elevation and changes of serum and drainage of IL-6, ESR, and CRP in the two groups were not significantly different.…”

“…Therefore, several clinical trials have been performed to evaluate the pain, function, and inflammation related to synovectomy in patients with knee OA at short-term follow-up [5–8,12] . A meta-analysis based on the previous clinical trials has demonstrated that conducting synovectomy in primary TKA for patients with OA does not relieve pain during 1-year follow-up period [14,22] . It was demonstrated in our study that excision or retention of synovium has little effect on postoperative pain post-TKA during a 10-year follow-up period.…”

Chondrocalcinosis does not affect functional outcome and prosthesis survival in patients after total or unicompartmental knee arthroplasty: a systematic review

“…The worse outcome of these patients could have been be biased by the fact that all of them underwent radical synovectomy. However, a meta-analysis reviewing five RCTs [ 38 ] about concomitant synovectomy during TKA detected no significant difference in clinical and functional KSS or range of motion postoperatively.…”

Current review of surgical management options for total knee arthroplasty in the rheumatoid knee

“…At the time of replacement, it is recommended that this be performed uniformly in patients with active synovitis. Synovectomy is possibly not required if the disease is silent and the synovium is not inflamed [13,14].…”