Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Synovectomy for inflammatory arthritis of the knee

INTRODUCTION

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, pigmented villonodular synovitis), 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 "Surgical therapy of osteoarthritis".)

DIAGNOSIS

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.

        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2014. | This topic last updated: Jan 16, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Paus AC, Førre O, Pahle JA, et al. A prospective clinical five year follow up study after open synovectomy of the knee joint in patients with chronic inflammatory joint disease. The prognostic power of clinical, arthroscopic, histologic and immunohistologic variables. Scand J Rheumatol 1992; 21:248.
  2. Ishikawa H, Ohno O, Hirohata K. Long-term results of synovectomy in rheumatoid patients. J Bone Joint Surg Am 1986; 68:198.
  3. McEwen C. Multicenter evaluation of synovectomy in the treatment of rheumatoid arthritis. Report of results at the end of five years. J Rheumatol 1988; 15:765.
  4. Montane I, McCollough NC 3rd, Lian EC. Synovectomy of the knee for hemophilic arthropathy. J Bone Joint Surg Am 1986; 68:210.
  5. Rydholm U, Elborgh R, Ranstam J, et al. Synovectomy of the knee in juvenile chronic arthritis. A retrospective, consecutive follow-up study. J Bone Joint Surg Br 1986; 68:223.
  6. Triantafyllou SJ, Hanks GA, Handal JA, Greer RB 3rd. Open and arthroscopic synovectomy in hemophilic arthropathy of the knee. Clin Orthop Relat Res 1992; :196.
  7. Doets HC, Bierman BT, von Soesbergen RM. Synovectomy of the rheumatoid knee does not prevent deterioration. 7-year follow-up of 83 cases. Acta Orthop Scand 1989; 60:523.
  8. Ogilvie-Harris DJ, Basinski A. Arthroscopic synovectomy of the knee for rheumatoid arthritis. Arthroscopy 1991; 7:91.
  9. Ogilvie-Harris DJ, Weisleder L. Arthroscopic synovectomy of the knee: is it helpful? Arthroscopy 1995; 11:91.
  10. Takagi T, Koshino T, Okamoto R. Arthroscopic synovectomy for rheumatoid arthritis using a holmium:YAG laser. J Rheumatol 2001; 28:1518.
  11. Chalmers PN, Sherman SL, Raphael BS, Su EP. Rheumatoid synovectomy: does the surgical approach matter? Clin Orthop Relat Res 2011; 469:2062.
  12. Cruz-Esteban C, Wilke WS. Innovative treatment approaches for rheumatoid arthritis. Non-surgical synovectomy. Baillieres Clin Rheumatol 1995; 9:787.
  13. Bessant R, Steuer A, Rigby S, Gumpel M. Osmic acid revisited: factors that predict a favourable response. Rheumatology (Oxford) 2003; 42:1036.
  14. Sledge CB, Zuckerman JD, Shortkroff S, et al. Synovectomy of the rheumatoid knee using intra-articular injection of dysprosium-165-ferric hydroxide macroaggregates. J Bone Joint Surg Am 1987; 69:970.
  15. Jacob R, Smith T, Prakasha B, Joannides T. Yttrium90 synovectomy in the management of chronic knee arthritis: a single institution experience. Rheumatol Int 2003; 23:216.
  16. Jahangier ZN, Jacobs JW, Lafeber FP, et al. Is radiation synovectomy for arthritis of the knee more effective than intraarticular treatment with glucocorticoids? Results of an eighteen-month, randomized, double-blind, placebo-controlled, crossover trial. Arthritis Rheum 2005; 52:3391.