Synovectomy of the Knee

Abstract

Summary Synovectomy of the knee is a useful procedure in diseases of the synovial membrane, which include synovial osteochondromatosis, pigmented villonodular synovitis, arborescent synovial lipoma, diffuse synovial hemangiomata, the unusual case of the synovial phase of tuberculosis, and coccidioidal synovitis. The most widespread usage of synovectomy today is in rheumatoid arthritis. Synovectomy should be performed in rheumatoid arthritis when the joint motion is good, there is no ligamentous instability, and the roentgenograms show little or no erosion. The white line of the subchondral plate of bone of the tibia and femur should be carefully examined for areas of indistinctness or breaks in continuity. Any such areas may represent erosions of bone. The type of rheumatoid arthritis that produces a synovial mass or proliferative synovitis responds well to synovectomy. The adhesive capsulitis or dry form of rheumatoid arthritis, which produces little synovitis, does not respond well to synovectomy. The best results from synovectomy of the knee can be achieved by early postoperative motion. Manipulation is not performed routinely. Relief of pain may be dramatic, and motion is usually maintained. The problem of recurrent synovitis has yet to be settled; it can be the result of either of two factors. One is the obvious recurrence of the rheumatoid disease process; the other is inflammatory synovitis as a result of incongruity of the joint surfaces already damaged by rheumatoid arthritis. It is not possible to distinguish between these two mechanisms at the present time. Synovectomy of the knee is a highly effective means of relieving pain in the patient with rheumatoid arthritis. It should be performed when the disease is progressive but before joint damage is severe, if the best results are to be obtained.