Synovectomy for inflammatory arthritis of the knee
- R John Wright, MD
R John Wright, MD
- Assistant Professor
- Harvard Medical School
- Section Editor
- Daniel E Furst, MD
Daniel E Furst, MD
- Section Editor — Treatment Issues in Rheumatology
- Professor of Rheumatology, University of Washington, Seattle
- Professor of Rheumatology, Washington University of Florence, Florence, Italy
- Professor of Rheumatology, University of California in Los Angeles (Emeritus)
- Director of Research, Pacific
Synovectomy refers to the destruction or surgical removal of the membrane (synovium) that lines a joint. As the largest articulation and the one most frequently affected by chronic inflammation, the knee is the joint most often selected for synovectomy. Open surgical, chemical, radiation, and arthroscopic synovectomies are all options for removing potentially damaging synovium from the knee.
There are various disorders that are indications for synovectomy. Among them are chronic inflammatory arthritides (eg, rheumatoid arthritis, psoriatic arthritis, Lyme arthritis), benign neoplastic disorders (eg, osteochondromatosis, tenosynovial giant cell tumor [formerly pigmented villonodular synovitis]), and recurrent hemarthrosis (eg, hemophilia). (See appropriate topics.)
Surgical debridement of synovial tissue, either open or arthroscopic, is also indicated for the treatment of some joint infections. (See "Septic arthritis in adults".)
The role of synovectomy in the diagnosis and management of inflammatory arthritis of the knee is reviewed here. Synovectomy has a limited role in treatment of osteoarthritis of the knee, and the use of arthroscopy in that setting is discussed separately. (See "Overview of surgical therapy of knee and hip osteoarthritis".)
In chronic inflammatory arthritis of the knee, microbiologic and histopathologic examination of synovium may be useful in diagnostic and prognostic studies. Arthroscopically guided synovial biopsy is an attractive alternative to closed needle biopsy techniques.
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