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Arthroscopic synovectomy of the metacarpophalangeal and proximal interphalangeal joints

Isato Sekiya1, Masaaki Kobayashi, Hideki Okamoto

  • 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan. i_sekiya@yahoo.co.jp

Techniques in Hand & Upper Extremity Surgery
|December 9, 2008
PubMed

Insights

Arthroscopic synovectomy effectively treats rheumatoid arthritis in finger joints, offering a minimally invasive option for metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. This procedure aids in assessing joint health and reducing inflammation.

Area of Science:

  • Orthopedic Surgery
  • Rheumatology
  • Minimally Invasive Procedures

Background:

  • Limited clinical data exists on finger joint arthroscopy, particularly for rheumatoid arthritis.
  • Arthroscopic synovectomy for rheumatoid fingers has received insufficient attention.
  • Rheumatoid arthritis commonly affects metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, causing inflammation and joint damage.

Purpose of the Study:

  • To describe the clinical experience with arthroscopic synovectomy of MCP and PIP joints in patients with rheumatoid arthritis.
  • To evaluate the feasibility and outcomes of arthroscopic synovectomy for rheumatoid finger joints.
  • To introduce novel portal techniques for improved access in PIP joint arthroscopy.

Main Methods:

  • Arthroscopic synovectomy was performed on 45 finger joints (18 MCP, 26 PIP, 1 thumb IP) in 23 rheumatoid arthritis patients.
  • Procedures utilized a 1.5 mm arthroscope and a 2.5 mm mini shaver system under regional anesthesia on an outpatient basis.
  • New dorsolateral portals were developed for PIP joint access, positioned more laterally than previous approaches.

Main Results:

  • Intraarticular structures, including articular cartilage and synovium, were well visualized.
  • Arthroscopic synovectomy of the dorsal capsule was safely performed using a 2-portal technique.
  • No post-procedural complications were observed; joint swelling resolved and did not recur long-term, with no reoperations needed.

Conclusions:

  • Arthroscopy of MCP and PIP joints is a valuable tool for assessing joint structures in rheumatoid arthritis.
  • Arthroscopic synovectomy of the dorsal capsule is a safe and effective procedure for rheumatoid finger joints.
  • The technique facilitates diagnosis and treatment, potentially improving patient outcomes in rheumatoid arthritis management.

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