Rheumatoid synovectomy: does the surgical approach matter?

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Evidence-Based Medicine

Background:

• Rheumatoid arthritis (RA) treatment often involves surgical synovectomy to alleviate pain.
• The comparative efficacy of arthroscopic versus open synovectomy for RA management remains unclear regarding pain, recurrence, disease progression, and need for joint replacement.

Purpose of the Study:

• To compare arthroscopic and open synovectomy in RA patients.
• To evaluate differences in pain relief, synovitis recurrence, radiographic progression, and subsequent arthroplasty rates.
• To determine if synovectomy is effective in advanced RA with degenerative joint changes.

Main Methods:

• Systematic review and meta-analysis of 58 studies (36 open, 22 arthroscopic synovectomy) involving 2589 patients.
• Mean follow-up of 6.1 years.
• Comparison of pain reduction, synovitis recurrence, radiographic progression, and need for total joint arthroplasty (TJA) or arthrodesis between arthroscopic and open synovectomy, focusing on knees and elbows.

Main Results:

• Arthroscopic synovectomy yielded comparable pain reduction to open synovectomy.
• Arthroscopic procedures were associated with higher rates of synovitis recurrence and radiographic progression.
• Patients undergoing arthroscopic synovectomy had similar risks for subsequent elbow arthroplasty and decreased risks for knee arthroplasty.
• Preoperative advanced radiographic RA did not predict worse pain or increased need for subsequent arthroplasty.

Conclusions:

• While offering similar pain relief, arthroscopic synovectomy may increase the risk of RA recurrence and radiographic progression compared to open synovectomy.
• Advanced degenerative joint disease should not preclude patients from undergoing synovectomy.