RESEARCH - Survival analysis and longterm results of elbow synovectomy in rheumatoid arthritis

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J Rheumatol. 2006 May;33(5):892-6.

Survival analysis and longterm results of elbow synovectomy in

rheumatoid arthritis.

Fuerst M, Fink B, Rüther W.

Department of Orthopaedics, Clinic of Joint replacement, Markgröningen, Germany.

OBJECTIVE: To evaluate longterm results and survival rate of open

synovectomy of the elbow joint in patients with rheumatoid arthritis

(RA).

METHODS: Between 1986 and 2000, synovectomy of the elbow was performed

on 103 joints in 92 patients with RA. Eighty-five joints were included

in this study. Mean age at time of surgery was 52 years (range 13 to

62 yrs). On 13 elbows with Larsen stage I and II disease, early

synovectomy preserving the radial head was performed; in 72 cases with

Larsen stage III and IV, late synovectomy with radial head resection

was necessary.

RESULTS: In early synovectomy, one joint received prosthetic joint

replacement and 2 joints underwent resynovectomy a mean of 9 years

after primary surgery. The survival rate (no further operations) was

91% after 5 years and 78% after 10 years. In late synovectomy, 16

elbow joints were operated again a mean of 4.6 years after primary

surgery (10 prosthetic joint replacements, 2 resection interposition

arthroplasties, 4 resynovectomies). Survival rate was 82% after 5

years and 66% after 10 years. Sixty-one elbows were examined

clinically at a mean followup period of 8.7 years (range 2.8-17.3

yrs). There was a significant improvement of the Morrey score at

followup, especially due to effective relief of pain. Improvement of

joint motion was seen in late synovectomy for pronation and

supination. The mean preoperative Larsen stage was 3.11, which

decreased significantly to 3.66 at followup.

CONCLUSION: Our findings suggest that synovectomy is a safe and

effective procedure in differential treatment of RA of the elbow.

PMID: 16652420

http://www.ncbi.nlm.nih.gov/pubmed/16652420

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