[Synovectomy of the rheumatoid elbow]

We present a comparative study of 120 elbow synovectomies with and without radial head resection performed between 1985 and 1993. Minimal radiological destruction according to Larsen stage 1-2 was present in 38 joints; 28 patients were followed postoperatively for an average period of 8.2 years. Synovectomy was combined with radial head resection in 70 patients (82 joints) where rheumatoid arthritis had radiologically proceeded to Larsen stage 3-4. Fifty patients were available for clinical and radiological follow-up. The follow-up period ranged from 6 to 15 years (average: 9.3 years). All patients in both groups were suffering from rheumatoid arthritis, and the proportion of females dominated. The mean age at the time of operation was 50 and 56 years, respectively. The results according to Inglis and Pellicci (16) were graded as good and excellent in 63.3% (19 joints) after elbow synovectomy. An average postoperative score result of 80.7 points (range: 43-96 points) was obtained. Synovectomy and radial head resection achieved comparable score results (75.7 points), representing 59.4% (35 joints) good and excellent ratings. Complete pain relief was obtained in 51.5%, and 27.1% complained of slight pain after elbow synovectomy. Of the patients who underwent radial head excision, 45.8% were pain free and 27.1% experienced slight pain. The range of motion of combined extension and flexion averaged 113 degrees and 110 degrees, respectively. A comparable improvement concerning pro/supination was maintained at final follow-up with an average gain of 20.4 degrees after synovectomy and 25.3 degrees for the latter group. We routinely noticed a moderate radiographic progression in both groups according to the criteria of the Larsen classification. The radiographic deterioration did not correlate with the clinical outcome. Synovectomy of the rheumatoid elbow is a valuable procedure in early as well as late stages of the disease. Our long-term results after synovectomy of the elbow prove significant pain relief and restoration of elbow function. The radiographic assessment revealed a moderate radiological deterioration. From the clinical viewpoint, the elbow function is maintained for a long time and valuable time is gained before reconstructive surgery may become necessary.