Treatment of knee osteoarthritis by arthroscopic synovectomy and debridement of cartilage lesions--late results.
Osteoarthritis (OA) is accompanied by degeneration and destruction of the articular cartilage, development of inflammatory process in the synovial membrane and periarticular tissues. Despite the introduction of new modern medications, the articular inflammatory changes often progress and therapy gives only a transitory improvement. Arthroscopic synovectomy (AS) in knee OA combined with resection of the cartilage lesions is a mild operative procedure and is not associated with postoperative joint stiffness and necessity of continuous rehabilitation.


OBJECTIVE
The aim of our study was to assess the late results in primary OA of the knee joint after arthroscopic synovectomy with resection of the cartilage lesions and tidal lavage. AS was performed in 71 patients with primary knee OA and chronic synovitis. The diagnosis OA of the knee joint was made according the criteria of American College of Rheumatology (1986).


METHODS
All patients, included in the study, had OA resistant to the conventional treatment. The arthroscopy was performed with a 30 degrees oblique optical system under local anesthesia. The synovectomy was performed with rotative resectors. The toilet of the articular cartilage includes the removal of macroscopic non-vital cartilage and free intraarticular bodies followed by monitored tidal lavage.


RESULTS
The patients were examined before the arthroscopy and followed-up in 1, 3 and 5 years after AS. For the clinical assessment the WOMAC test was used. The WOMAC functional index shows statistically significant improvement at 1 and 3 years (p < 0.0001), as well as at 5 years (p < 0.001) after AS. The WOMAC pain index was significantly reduced in the arthroscopic joint at 1 and 3 years (p < 0.0001). The good therapeutic result was maintained for 5 years (p < 0.001). The WOMAC joint stiffness index was improved to the greatest extent 1 and 3 years after AS (p < 0.0001). In the 5th year a favourable statistically significant improvement was preserved. The total WOMAC index showed a durable general functional improvement including 3 years after the AS. The AS was performed in advanced OA of the knee joint accompanied with a chronic synovitis, resistant to medical therapy and topical management. The functional therapeutic results from AS were very good and lasting even 5 years after the AS.
Kuzmanova
Stefka I
SI
Clinic of Rheumatology, Medical University--Plovdiv, Bulgaria.
D001182:Arthroscopy / Q000379:methods*; D002358:Cartilage, Articular / Q000601:surgery*; D003646:Debridement / Q000379:methods*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D020127:Recovery of Function; D012720:Severity of Illness Index; D000074402:Synovectomy; D016896:Treatment Outcome