title: Good long-term outcome of synovectomy in advanced stages of the rheumatoid elbow.
abstract: OBJECTIVE
  Synovectomy is an effective procedure for management of the rheumatoid elbow at radiographically early stages (Larsen grades 1 and 2). However, its efficacy for advanced stages (Larsen grades 3-5) is controversial. We investigated the outcome of synovectomy for advanced stages of the rheumatoid elbow.
  
  
  METHODS
  Between May 1985 and September 1994, synovectomy was performed for 67 rheumatoid elbows in 59 patients (mean age 52 (26-72) years, 54 women). 3 elbows (3 patients) were lost to follow-up after mean 15 (10-23) years. Thus, 64 elbows were evaluated clinically and radiographically.
  
  
  RESULTS
  The mean Mayo elbow performance score (MEPS) improved from 42 (15-75) points preoperatively to 78 (45-100) points at the final follow-up examination. In cases of Larsen grade 5, the mean MEPS at final follow-up examination (69 points) was lower than those of Larsen grade 3 and 4 cases (80 and 79 points, respectively) (p < 0.01). Recurrence of synovitis was obvious in 20/67 elbows. 12 cases had a total elbow arthroplasty mean 13 years after the synovectomy. The 10-year, 15-year, and 20-year survival rates were 97%, 75%, and 70%, respectively.
  
  
  CONCLUSIONS
  Our findings suggest that synovectomy for the rheumatoid elbow gives a good long-term outcome for radiographically judged destroyed joints of Larsen grades 3-4.
authors.affiliation: Department of Orthopaedic Surgery, Yokohama City University, Japan. ishi69@yokohama-cu.ac.jp
authors.forename: Katsushi
authors.initials: K
authors.lastname: Ishii
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Inaba
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Mochida
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D000074402:Synovectomy; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome