Early and late synovectomy of the knee in rheumatoid arthritis

The results after open knee synovectomy in the treatment of rheumatoid arthritis were investigated in a retrospective study including 44 patients with 55 knees. Median observation time was 73 months. Early synovectomy showed significant pain-relief and improvement of knee function, effusion was reduced and range of motion was unchanged. Total knee alloplasty (TKA) was performed in one knee among the patients who underwent early synovectomy, while reoperation with TKA had been performed in 12 out of 28 knees after late synovectomy. It is concluded that early synovectomy is indicated when medical treatment has failed. Late synovectomy must be regarded as a palliative procedure in order to postpone TKA.     

A synovectomy trial and the history of early knee synovitis in rheumatoid arthritis

The results of a randomized synovectomy trial are reported and the history of early knee synovitis in 121 patients with rheumatoid arthritis is described. Conservative treatment (rest in splints, non-steroidal anti-inflammatory drugs and gold or an anti-malaria agent) for 4-5 months led to improvement in 81 of the 121 patients with early knee synovitis. In one-third of these 81 patients, the improvement continued, according to their own and the doctor's opinion, during 5 years of follow-up. Ten of the 22 patients who fulfilled the criteria for the synovectomy trial were operated upon. They showed improvement for 4 years. Over the 5-year period, two-thirds of the group were constantly seropositive or seronegative and in the other third the serology varied, but such that at each assessment 50% of the group were seropositive. Radiologically, all of the patients showed deterioration. The surgical group deteriorated more slowly for the first 2-3 years, but then showed the same pattern as the other groups. The disappearance of the clinical features of synovitis does not mean that radiological deterioration has ceased.     

Role of early synovectomy of the knee joint in rheumatoid arthritis

The prospective study of 32 knees in 26 patients with rheumatoid arthritis was carried out with an average followup of 3 years. Relief of pain and control of inflammation locally were obtained in 22 of 32 knees (69%). Articular cartilage was preserved in 20 of 28 knees (71%) and the synovitis recurred in 9 knees (28%), 7 of which showed progressive loss of cartilage. Therefore, it appears that synovectomy, if performed at a stage in which articular cartilage is still normal and after medical therapy has failed, is a very effective method for preserving articular cartilage and controlling inflammation locally. However, with a longer followup the disease with loss of articular cartilage will recur in a large number of cases. In patients whose disease progresses rapidly, no form of therapy effectively controls joint destruction.     

Long-term results of knee synovectomy in early cases of rheumatoid arthritis

Summary Five hundred and eight cases of early synovectomy of the knee in rheumatoid arthritis are reported from nine clinics in a retrospective multi-center follow-up study. Observation time covers at least ten years in each case. Sixty-five per cent of the cases are reported as being subjectively and objectively good. The mean roentgenological grade, according to Larsen, was 1.7 preoperatively and 2.7 at follow-up.A multi-center retrospective study presented by European Rheumatoid Arthritis Surgical Society (ERASS) at the Tenth European Congress of Rheumatology in Moscow 1983.     

Controlled trial of synovectomy of knee and metacarpophalangeal joints in rheumatoid arthritis

Arthritis and Rheumatism Council and British Orthopaedic Association (1976).Annals of the Rheumatic Diseases, 35, 437-442. Controlled trial of synovectomy of knee and metacarpophalangeal joints in rheumatoid arthritis. In a multicentre study patients with rheumatoid arthritis judged by prevailing criteria to be suitable for synovectomy of the knee or metacarpophalangeal (MCP) joints were randomly allocated to one of two groups. One group had the operation, the other was observed without operation from a notional corresponding date. 3 years later the outcome of synovectomy was compared with that of observation without synovectomy. Synovectomy of the knee was followed by significantly less pain and tenderness, smaller effusions, and smaller and less frequent erosions and geodes. By contrast, MCP joints were no better clinically or radiographically than those treated conservatively. The results have been compared with those of two other controlled trials, one concerned with the knee and MCP joints, the other only with MCP joints. In the present trial results were more favourable in the knee but comparable in the MCP joints with those reported in the first of these two trials but less favourable in the MCP joints than those observed in the second.     

Comparison of synovectomy and no synovectomy in patients with juvenile rheumatoid arthritis. A 24-month controlled study

Thirty patients with pauciarticular or polyarticular juvenile rheumatoid arthritis entered a randomized, 24-month, parallel trial of synovectomy (n = 15) versus no synovectomy (n = 15). The joints studied were 18 wrists, 8 ankles and 4 knees. The synovectomies were performed as radically as possible. Joint motion was slightly decreased in the operated joints, especially for passive movements during the first 6 months following surgery. Swelling and disease activity of the joints studied as well as subjective evaluation of joint pain improved in the synovectomy group compared with the non-synovectomy group. This improvement seemed to continue for at least 2 years.     

Follow-up results of arthroscopic synovectomy for the rheumatoid knee

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. Received: September 5, 2000 / Accepted: January 29, 2001     

Multicenter evaluation of synovectomy in the treatment of rheumatoid arthritis

A controlled multicenter evaluation of synovectomy in the treatment of rheumatoid arthritis followed 59 patients for 3 years. Finger joints and knees were studied. After 1 year synovectomized joints were better than controls in several features. After 3 years these differences had disappeared in the fingers, but swelling remained less in synovectomized knees. Recurrences were as frequent in synovectomized as in control finger joints, but were slightly less frequent in synovectomized than in control knees. Radiologic bony erosions in fingers and knees of both groups progressed equally during the 3 years.     

Non-Hodgkin's lymphoma of the synovium simulating rheumatoid arthritis

Skeletal involvement in patients with non-Hodgkin's lymphoma (NHL) is common, although direct involvement of the joints is unusual. We describe 2 adults who presented with features suggestive of a diagnosis of rheumatoid arthritis, but who were found to have diffuse NHL of the synovium. Results of a review of the literature, and assessment of the few similar cases in which NHL presented in the joint, suggest that the lymphoma may mimic either a monarticular or polyarticular synovitis, without lymphadenopathy or hepatosplenomegaly. Radiographic demonstration of associated bone destruction is the best evidence for non-Hodgkin's lymphomatous arthropathy in patients with rheumatic symptoms.