RESEARCH - Arthroscopic and open synovectomy of the elbow in RA

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J Bone Joint Surg Am. 2006 Mar;88(3):521-5.

Arthroscopic and open synovectomy of the elbow in rheumatoid arthritis.

Tanaka N, Sakahashi H, Hirose K, Ishima T, Ishii S.

Sapporo Gorinbashi Orthopaedic Hospital, Gorinbashi Health Care

Facilities and Hospitals, 2-1, Kawazoe, Minami-ku, Sapporo, Hokkaido

005-0802, Japan.

BACKGROUND: Synovectomy has been advocated for early treatment of the

rheumatoid elbow. It has not been determined whether arthroscopic or

open synovectomy is better and whether a preoperative arc of flexion

of >90 degrees is an important prognostic factor.

METHODS: Arthroscopic or open synovectomy was performed in fifty-eight

elbows in fifty-three patients with rheumatoid arthritis and

radiographic changes in the joint of Larsen grade 2 or less. Clinical

symptoms, recurrent synovitis, postoperative complications, and

radiographic changes were assessed ten to eighteen years (average,

thirteen years) postoperatively.

RESULTS: Eleven (48%) of twenty-three elbows in which arthroscopic

synovectomy had been performed and sixteen (70%) of twenty-three

elbows in which open synovectomy had been performed were mildly or not

painful at the latest follow-up evaluation. However, no significant

difference was detected between the overall clinical results of

arthroscopic synovectomy and those of open synovectomy. In elbows with

a preoperative arc of flexion of <90 degrees , the clinical results of

the two procedures were comparable. In elbows with a preoperative arc

of flexion of <90 degrees , arthroscopic synovectomy provided

significantly (p < 0.05) better function than open surgery after

mid-term follow-up, and motion and function continued to be better in

those patients at the most recent follow-up evaluation. Recurrent

synovitis was observed in six elbows that had arthroscopic synovectomy

and in three that had open synovectomy, and the Larsen grade increased

in both groups. Three elbows with a preoperative arc of flexion of <90

degrees underwent a total elbow arthroplasty to treat ankylosis after

open synovectomy. Surgical complications were uncommon and not severe.

CONCLUSIONS: Arthroscopic synovectomy of the elbow is a reliable

procedure. One of the most favorable indications for either

arthroscopic or open synovectomy is a preoperative arc of elbow

flexion of >/=90 degrees in patients with early rheumatoid arthritis.

PMID: 16510817

http://www.ncbi.nlm.nih.gov/pubmed/16510817

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