Treatment of chronic knee synovitis with arthroscopic synovectomy: longterm results

We examined the longterm results of arthroscopic synovectomy in chronic knee synovitis of rheumatoid arthritis (RA).

Forty-one knees of 38 patients (30 women, 8 men), mean age of 42.7 +/- 15.3 years, were evaluated clinically and radiographically at a mean 8.9 years (range 5.0-12.3) after arthroscopic synovectomy. Arthroscopic synovectomies were always performed with a shaver by the same physician after failure of at least one radioactive or chemical synovectomy. Radiographs were blindly read by 2 examiners.

At the final evaluation, the clinical results (pain, range of motion, recurrent effusion) were good in 29 cases (70.7%) and poor in 12 cases (knee arthroplasty was required in 11 cases). Radiographs highlighted significant progression of joint damage (more than one Larsen score grade) in 16 knees (39.0%). No radiographically detectable change was observed in 12 cases (29.3%), and 11 knees (26.8%) had a change of only one Larsen score grade. There was a close correlation between the Larsen score at final examination and both Larsen score and arthroscopic score for cartilage damage at baseline. Only 4 knees (22%) with grade 0 or I on preoperative radiographs had significant progression of joint damage, compared to 12 knees (57%) with Larsen scores of 2 or 3 at baseline.

These data suggest that arthroscopic synovectomy is a useful alternative treatment for chronic knee synovitis in RA after failure of radiation or chemosynovectomy, and that less severely damaged joints deteriorate less rapidly after synovectomy.