Arthroscopic synovectomy of the knee in rheumatoid arthritis defined by the 2010 ACR/EULAR criteria.
BACKGROUND
The aims of this study were: (1) to evaluate the mid-term results and survivorship of arthroscopic synovectomy (AS) of the knee in rheumatoid arthritis (RA) defined with the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria; and (2) to identify prognostic factors.


METHODS
Patients matching the 2010 ACR/EULAR criteria, with symptomatic knee synovitis for at least six months, treated with arthroscopic synovectomy of the knee at a minimum of three year followup were included. Pre-operative evaluation included Larsen, HAQ, DAS28, and Laurin scores. Post-operatively, Laurin, WOMAC, and patient satisfaction scores were evaluated. Different variables were investigated to find associations with the outcomes. Kaplan-Meier survival analysis was performed.


RESULTS
Sixty-four patients met the inclusion criteria. Seven patients (9.6%) were lost to followup, leaving 57 patients (66 knees) for the present study. The average followup was 96.3months (SD 41). The pre-operative Laurin score was 3.91 points (SD 1.3) and significantly (P<0.001) improved after surgery (mean 8.2, SD 2). The post-operative average WOMAC score was 73.9 points (SD 45.9). Eighteen knees (27.3%) underwent revision procedures at an average of 48.6 months (SD 39.8). Joint degeneration (Larsen grade III) and range of movement (ROM) reduction (>10%) were identified as negative prognostic factors. Kaplan-Meier survivorship with total knee replacement as endpoint was: 78% at one year, 28% at four years, and six percent at 10 years.


CONCLUSIONS
Although AS of the knee has still a role as a salvage procedure in the treatment of RA synovitis with initial joint degeneration (less than Larsen grade III) and good ROM, high revision rates and limited survivorship are reported.
University of Torino, CTO Hospital, 2nd Department of Orthopaedics and Traumatology, Torino, Italy.
Pierfranco
P
Triolo
University of Torino, AO Mauriziano "Umberto I" Hospital, Department of Orthopaedics and Traumatology, Torino, Italy.
Roberto
R
Rossi
University of Torino, AO Mauriziano "Umberto I" Hospital, Department of Orthopaedics and Traumatology, Torino, Italy.
Federica
F
Rosso
University of Torino, AO Mauriziano "Umberto I" Hospital, Department of Orthopaedics and Traumatology, Torino, Italy.
Davide
D
Blonna
University of Torino, CTO Hospital, 2nd Department of Orthopaedics and Traumatology, Torino, Italy.
Filippo
F
Castoldi
University of Torino, AO Mauriziano "Umberto I" Hospital, Department of Orthopaedics and Traumatology, Torino, Italy. Electronic address: debonasia@gmail.com.
Davide Edoardo
DE
Bonasia
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000601:surgery*; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D016879:Salvage Therapy; D000074402:Synovectomy; D013585:Synovitis / Q000601:surgery*; D055815:Young Adult
Arthroscopy; Knee; Rheumatoid arthritis; Synovectomy