Arthroscopic synovectomy for the rheumatoid elbow.
OBJECTIVE
To describe an arthroscopic technique for complete removal of the synovium from the elbow joint and to investigate the clinical outcomes of arthroscopic synovectomy in patients with rheumatoid elbow.


METHODS
Arthroscopic synovectomy was performed on 26 rheumatoid elbows in 25 patients with radiographic changes of Larsen grade 3 or less. We performed total synovectomy of the elbow using multiple portals and by dividing the elbow into the anterior, posterior, and radiocapitellar compartments. At a mean follow-up of 33.9 months (range, 13 to 68 months), pain was evaluated with a visual analog scale and range of motion was measured. The Mayo Elbow Performance Score was used to assess total elbow function. Radiologic changes were determined according to the Larsen grading system.


RESULTS
The mean visual analog scale score for pain decreased from 6.5 to 3.1, and the mean flexion arc increased from 98.1 degrees to 113.3 degrees after the operation. The mean Mayo Elbow Performance Score improved from 58.5 to 77.4 points. There were 2 excellent, 17 good, 4 fair, and 3 poor results. Radiologic assessment showed no change in 13 elbows, improvement in 6, and progression in 7. Clinically apparent synovitis recurred in 4 elbows, in which the result was considered unsuccessful.


CONCLUSIONS
Arthroscopic synovectomy of the elbow by use of multiple portals is a technically feasible procedure. It can effectively relieve pain, increase range of motion, improve Mayo Elbow Performance Score, and delay radiologic progression in rheumatoid elbows, resulting in a high satisfaction rate, although recurrent synovitis occurs in some patients.


METHODS
Level IV, therapeutic case series.
Kang
Hong Je
HJ
Department of Orthopedic Surgery, Wonkwang University, Iksan, South Korea.
Park
Min Jong
MJ
Ahn
Jin Hwan
JH
Lee
Sang Hak
SH
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D003131:Combined Modality Therapy; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000074402:Synovectomy; D013585:Synovitis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
D018501:Antirheumatic Agents