Comparison of the efficacy of nonsurgical synovectomy (synoviorthesis) and joint lavage in knee osteoarthritis with effusions.
OBJECTIVE
Radioactive or chemical synovectomy (synoviorthesis) is widely used as local therapy for inflammatory joint disease in France. The objective of this retrospective study was to compare the efficacy of osmic acid or radiation synovectomy with that of joint lavage for the treatment of knee osteoarthritis with effusions.


METHODS
All study patients met American College of Rheumatology criteria for knee osteoarthritis, which was symptomatic despite conservative therapy including local corticosteroid injections. Fifty-four patients were treated by synoviorthesis (osmic acid, n = 16; yttrium 90, n = 76) and 45 by joint lavage (total 67 lavages).


RESULTS
Thirty two per cent of the patients in the synoviorthesis group had a good or excellent outcome after six months. Results were better with yttrium 90 than with osmic acid. Improvements were most marked in patients with chondrocalcinosis. Efficacy was negatively correlated with the femorotibial lesions but not with the patellofemoral lesions. Patients with knee alignment disorders had poorer outcomes. In the joint lavage group, 30% of the knees showed improvements after three months and results were significantly better after three and six months when the lavage was followed by an injection of triamcinolone hexacetonide. No side effects were recorded.


CONCLUSIONS
Our data suggest that chemical or radiation synovectomy or joint lavage followed by injection of a delayed-action steroid may be useful for the treatment of knee osteoarthritis with chronic or recurrent effusions.
Hilliquin
P
P
Rheumatology Department A, Cochin Teaching Hospital, Paris, France.
Le Devic
P
P
Menkès
C J
CJ
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects*; D008875:Middle Aged; D009993:Osmium Tetroxide / Q000008:administration & dosage*; D010003:Osteoarthritis / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D013583:Synovial Membrane / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage*
D000305:Adrenal Cortex Hormones; D015021:Yttrium Radioisotopes; D009993:Osmium Tetroxide