Partial synovectomy in the treatment of tuberculosis of the knee

Fifty synovectomies of the knee joint for tuberculous synovitis performed during a six-year period with complete postoperative follow-up were studied to assess the value of such procedures and the conclusions drawn are reported here. In order to obtain good results, synovectomy should be performed during the early phase of disease, when the knee remains swollen and warm, even after antitubercular therapy, or when the range of movement does not show signs of returning. Exploration of such joints in children shows that the cartilage is wholly or partly covered by pannus. Removal of this pannus allows better nutrition of the cartilage and thus greatly reduces the number of children eventually requiring arthrodesis. Even in adults, when the disease is mainly synovial with pannus formation over the articular cartilages but without serious damage to the bony articular surface, partial synovectomy, or more precisely, joint clearance gives encouraging results and arthrodesis may only need to be performed in patients with severe forms of the disease, often involving the bony articular surfaces.