Experience with knee synovectomy in Norwich, 1964-1973

Area of Science:

• Orthopedics
• Rheumatology

Background:

• Rheumatoid arthritis frequently affects the knee joint, causing pain and functional limitations.
• Surgical interventions like synovectomy aim to manage inflammatory synovitis and its consequences.

Purpose of the Study:

• To evaluate the long-term efficacy of anterior synovectomy in rheumatoid knees.
• To assess the indications, contraindications, and failure modes of this procedure.

Main Methods:

• Personal review of 36 patients (43 knees) and examination of records for 7 additional patients (10 knees) who underwent anterior synovectomy between 1964 and 1973.
• Analysis of failure rates, causes of failure, and outcomes related to specific knee conditions.

Main Results:

• Twenty-five percent of knees were considered failures at review, with only two being immediate failures.
• Anterior synovectomy demonstrated effectiveness as a pain-relieving procedure.
• Indications were found to be broader than classically stated, including knees with full-thickness cartilage destruction and flexion deformities up to 20 degrees.
• Secondary degenerative changes were the primary cause of failure, manifesting as pain rather than stiffness.
• Postoperative manipulation did not negatively impact the final results.
• Five associated popliteal cysts were successfully treated by the synovectomy.

Conclusions:

• Anterior synovectomy is a valuable pain-relieving option for rheumatoid knees.
• The procedure's indications can be extended to include knees with significant cartilage loss and moderate flexion deformities.
• Long-term success is influenced by secondary degenerative processes, highlighting the need for ongoing management.