title: Arthroscopic and open synovectomy of the elbow in rheumatoid arthritis.
abstract: BACKGROUND
  Synovectomy has been advocated for early treatment of the rheumatoid elbow. It has not been determined whether arthroscopic or open synovectomy is better and whether a preoperative arc of flexion of >90 degrees is an important prognostic factor.
  
  
  METHODS
  Arthroscopic or open synovectomy was performed in fifty-eight elbows in fifty-three patients with rheumatoid arthritis and radiographic changes in the joint of Larsen grade 2 or less. Clinical symptoms, recurrent synovitis, postoperative complications, and radiographic changes were assessed ten to eighteen years (average, thirteen years) postoperatively.
  
  
  RESULTS
  Eleven (48%) of twenty-three elbows in which arthroscopic synovectomy had been performed and sixteen (70%) of twenty-three elbows in which open synovectomy had been performed were mildly or not painful at the latest follow-up evaluation. However, no significant difference was detected between the overall clinical results of arthroscopic synovectomy and those of open synovectomy. In elbows with a preoperative arc of flexion of <90 degrees , the clinical results of the two procedures were comparable. In elbows with a preoperative arc of flexion of <90 degrees , arthroscopic synovectomy provided significantly (p < 0.05) better function than open surgery after mid-term follow-up, and motion and function continued to be better in those patients at the most recent follow-up evaluation. Recurrent synovitis was observed in six elbows that had arthroscopic synovectomy and in three that had open synovectomy, and the Larsen grade increased in both groups. Three elbows with a preoperative arc of flexion of <90 degrees underwent a total elbow arthroplasty to treat ankylosis after open synovectomy. Surgical complications were uncommon and not severe.
  
  
  CONCLUSIONS
  Arthroscopic synovectomy of the elbow is a reliable procedure. One of the most favorable indications for either arthroscopic or open synovectomy is a preoperative arc of elbow flexion of >/=90 degrees in patients with early rheumatoid arthritis.
authors.affiliation: Sapporo Gorinbashi Orthopaedic Hospital, Gorinbashi Health Care Facilities and Hospitals, 2-1, Kawazoe, Minami-ku, Sapporo, Hokkaido 005-0802, Japan. nobuyuki.tanaka@ryumachi-jp.com
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakahashi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Hirose
authors.forename: Takumi
authors.initials: T
authors.lastname: Ishima
authors.forename: Seiichi
authors.initials: S
authors.lastname: Ishii
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000601:surgery*; D001182:Arthroscopy; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D000074402:Synovectomy; D016896:Treatment Outcome