Indications
- RA
- PVNS
- Hemophilia
Patient selection
- More than 6 months of persistent pain, effusion and stiffness, despite conservative treatment
- Functional class I or II
- Minimal radiographic changes
- Inactive phase of the underlying disease
Contra-indications
- Severe degenerative changes
- Significant limitation of ROM
Technique
Arthroscopic synovectomy
- Use a combination of antero-medial, antero-lateral and posterior portals to ensure complete removal
- Advantages
- Outpatient procedure
- Lower infection rate
- Lower overall morbidity rate
- Better post-op ROM
Chemicalsynovectomy
- Intra-articular injection of either
- An alkylating agent
- Osmic acid
- Abandoned because of the risk of cartilage damage
Radiationsynovectomy
- Intra-articular injection of a radioactive substance
- Currently, dysprosium 165 is the choice element, because of
- Short half-life (2 hours)
- Large molecular size, which decreases chance of systemic absorption
- Gold and yttrium can also be utilized for this purpose, but have longer half-lives (2-3 days)
Open surgical synovectomy
- An uncommon procedure nowadays
- Bears more risk of infection and morbidity
- Affects post-op ROM more than other techniques
Results
- The efficacy of different techniques is the same
- Significant decrease in pain and stiffness in 80% of cases, but the effects are temporary
- 50% of patients would need a 2nd procedure in 4 years
References
- Di Cesare PF : Knee. In Spivak JM, Di Cesare PE, Feldman DS : Orthopedics; A Study Guide; 1999, chapter 50
- Davis KM, King DS, Philips L, Lu Y, Edwards RB 3rd, Kalscheur V, Markel MD. : Comparison of surgical techniques for synovectomy in New Zealand; Am J Vet Res. 2004 May; 65(5):573-7.