Treatment of chronic knee synovitis with arthroscopic synovectomy: longterm results.
OBJECTIVE
We examined the longterm results of arthroscopic synovectomy in chronic knee synovitis of rheumatoid arthritis (RA).


METHODS
Forty-one knees of 38 patients (30 women, 8 men), mean age of 42.7 +/- 15.3 years, were evaluated clinically and radiographically at a mean 8.9 years (range 5.0-12.3) after arthroscopic synovectomy. Arthroscopic synovectomies were always performed with a shaver by the same physician after failure of at least one radioactive or chemical synovectomy. Radiographs were blindly read by 2 examiners.


RESULTS
At the final evaluation, the clinical results (pain, range of motion, recurrent effusion) were good in 29 cases (70.7%) and poor in 12 cases (knee arthroplasty was required in 11 cases). Radiographs highlighted significant progression of joint damage (more than one Larsen score grade) in 16 knees (39.0%). No radiographically detectable change was observed in 12 cases (29.3%), and 11 knees (26.8%) had a change of only one Larsen score grade. There was a close correlation between the Larsen score at final examination and both Larsen score and arthroscopic score for cartilage damage at baseline. Only 4 knees (22%) with grade 0 or I on preoperative radiographs had significant progression of joint damage, compared to 12 knees (57%) with Larsen scores of 2 or 3 at baseline.


CONCLUSIONS
These data suggest that arthroscopic synovectomy is a useful alternative treatment for chronic knee synovitis in RA after failure of radiation or chemosynovectomy, and that less severely damaged joints deteriorate less rapidly after synovectomy.
Roch-Bras
Françoise
F
Fédération de Rhumatologie, CHU Lapeyronie, Montpellier, France.
Daurès
Jean-Pierre
JP
Legouffe
Marie-Christine
MC
Sany
Jacques
J
Combe
Bernard
B
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome