Function of arthroscopy for early diagnosis and early therapeutic intervention in knee synovitis compared to histopathology

Abstract

Background and Aim: Osteoarthritis (OA) is the most common form of arthritis and a major cause of joint pain and disability. Synovial fluid analysis and biopsy have been found to be a valuable adjunct to conventional investigations and are routinely advised in most cases of joint diseases. Needle arthroscopy of the knee has been advocated as it allows good macroscopic evaluation of synovial inflammation and selective sampling of the synovial membrane thereby overcoming the disadvantage of closed needle biopsy.Material and Methods: In the decided study period, total of 60 cases were selected as per the inclusion and exclusion criteria decided prior to the start of the study. The clinical examination with movements in knee joints, valgus stress test, lachman test amd McMurrays test was done. After initial arthroscopic inspection, the structures like anterior cruciate ligament, medial and lateral menisci, tested and seen for their integrity and consistency. The synovial fluid was sent for cytology, culture and for biochemistry. The data was analyzed using proportions.Results: Overall in 24 cases the clinical diagnosis differed from that of gold standard i.e. histopathology. In six cases the diagnosis was chronic non-specific synovitis but it turned out to be Osteoarthritis on histopathology. In two cases the clinical diagnosis was chronic non-specific synovitis but it turned out to be pyogenic synovitis on histopathology. In two cases the clinical diagnosis was chronic non-specific synovitis but it turned out to be Villonodular synovitis s on histopathology. In six cases the diagnosis was septic arthritis but it turned out to be gouty arthritis on histopathology.Conclusion: Thus arthroscopic diagnosis can be relied upon and treatment can be started on this basis in view of time consuming and costly histopathological tests.