Synovectomy for inflammatory arthritis of the knee
- R John Wright, MD
R John Wright, MD
- Assistant Professor
- Harvard Medical School
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.
- 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.
- Ishikawa H, Ohno O, Hirohata K. Long-term results of synovectomy in rheumatoid patients. J Bone Joint Surg Am 1986; 68:198.
- 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.
- Montane I, McCollough NC 3rd, Lian EC. Synovectomy of the knee for hemophilic arthropathy. J Bone Joint Surg Am 1986; 68:210.
- 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.
- 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.
- 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.
- Ogilvie-Harris DJ, Basinski A. Arthroscopic synovectomy of the knee for rheumatoid arthritis. Arthroscopy 1991; 7:91.
- Ogilvie-Harris DJ, Weisleder L. Arthroscopic synovectomy of the knee: is it helpful? Arthroscopy 1995; 11:91.
- Takagi T, Koshino T, Okamoto R. Arthroscopic synovectomy for rheumatoid arthritis using a holmium:YAG laser. J Rheumatol 2001; 28:1518.
- Chalmers PN, Sherman SL, Raphael BS, Su EP. Rheumatoid synovectomy: does the surgical approach matter? Clin Orthop Relat Res 2011; 469:2062.
- Cruz-Esteban C, Wilke WS. Innovative treatment approaches for rheumatoid arthritis. Non-surgical synovectomy. Baillieres Clin Rheumatol 1995; 9:787.
- Bessant R, Steuer A, Rigby S, Gumpel M. Osmic acid revisited: factors that predict a favourable response. Rheumatology (Oxford) 2003; 42:1036.
- 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.
- 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.
- 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.
- Liepe K, Zaknun JJ, Padhy A, et al. Radiosynovectomy using yttrium-90, phosphorus-32 or rhenium-188 radiocolloids versus corticoid instillation for rheumatoid arthritis of the knee. Ann Nucl Med 2011; 25:317.
- Goetz M, Klug S, Gelse K, et al. Combined arthroscopic and radiation synovectomy of the knee joint in rheumatoid arthritis: 14-year follow-up. Arthroscopy 2011; 27:52.