Abstract
Purpose
The apparent synovial hypertrophy in some cases of noninflammatory knee osteoarthritis suggests that total synovectomy may provide beneficial inflammatory and pain relief after total knee arthroplasty. The aim of the study was to compare the effect of synovectomy on the postoperative pain, bleeding and functional outcome after surgical treatment of knee osteoarthritis.
Methods
A total of 50 patients with bilateral, non inflammatory, primary knee osteoarthritis were included in the study. Bilateral total knee replacement was performed at the same session. Total synovectomy and total knee arthroplasty (study group) were applied to a randomly selected side, and the total knee arthroplasty alone (as control group) was applied to the contralateral side of the same patient. The overall efficacy of both procedures was assessed postoperatively by determination of blood loss from the drain, pain and functional scores. The Visual Analogue Scale of pain and the Knee Society Knee Score were used to compare the two groups at 3rd, 6th and 12th months, postoperatively.
Results
During the postoperative 48 h, the mean blood loss in the study group (with synovectomy) was significantly higher than the control group (P = 0.005). However, in the postoperative follow-up time, there was no significant difference in pain relief and in the Knee Society Score between the two groups.
Conclusion
Performing synovectomy in patients with primary knee osteoarthritis does not seem to have any clinical advantage besides it might increase blood loss and recurrent hemarthrosis postoperatively. Thus, during arthroplasty surgery, it should not be performed routinely.
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References
Attur M, Samuels J, Krasnokutsky S, Abramson SB (2010) Targeting the synovial tissue for treating osteoarthritis (OA): where is the evidence? Best Pract Res Clin Rheumatol 24:71–79
Bullock DP, Sporer SM, Shirreffs TG Jr (2003) Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am 85:1981–1986
Cushner FD, Friedman RJ (1991) Blood loss in total knee arthroplasty. Clin Orthop Relat Res 269:98–101
Demey G, Servien E, Pinaroli A, Lustig S, Selmi T, Neyret T (2010) The influence of femoral cementing on perioperative blood loss in total knee arthroplasty. J Bone Joint Surg Am 92:536–541
Guermazi A, Zaim S, Taouli B et al (2003) MR findings in knee osteoarthritis. Eur Radiol 13:1370–1386
Hersekli MA, Akpinar S, Ozkoc G, Ozalay M, Uysal M, Cesur N, Tandoğan RN (2004) The timing of tourniquet release and its influence on blood loss after total knee arthroplasty. Int Orthop 28:138–141
Hunter DJ (2009) Imaging insights on the epidemiology and pathophysiology of osteoarthritis. Rheum Dis Clin North Am 35:447–463
Jones EA, Crawford A, English A et al (2008) Synovial fluid mesenchymal stem cells in health and early osteoarthritis: detection and functional evaluation at the single-cell level. Arthritis Rheum 58:1731–1740
Kanbe K, Takemura T, Takeuchi K, Chen Q, Takagishi K, Inoue K (2004) Synovectomy reduces stromal cell derived factor-1 (SDF-1) which is involved in the destruction of cartilage in osteoarthritis and rheumatoid arthritis. J Bone Joint Surg Br 86:296–300
Kubacki J, Kokosz M, Grygorowicz M, Adamczyk-Bujniewicz H (2006) The value of synovectomy of the knee in the treatment of rheumatoid arthritis. Ortop Traumatol Rehabil 8:99–105
Laskin RS (2008) The classic: total condylar knee replacement in patients who have rheumatoid arthritis. A ten-year follow-up study. 1990. Clin Orthop Relat Res 466:2589–2596
Lybäck CO, Belt EA, Savolainen HA (2004) Previous synovectomy or epiphyseal stapling and the influence on knee replacement in juvenile chronic arthritis. Int Orthop 28:134–137
Maslon A, Witonski D, Pieszynski I, Grzegorzewski A, Synder M (2007) Early clinical results of open and arthroscopic synovectomy in knee inflammation. Ortop Traumatol Rehabil 9:520–526
O’Connell JX (2000) Pathology of the synovium. Am J Clin Pathol 114:773–784
Ohdera T, Tokunaga M, Hiroshima S et al (2004) Recurrent hemarthrosis after knee joint arthroplasty: etiology and treatment. J Arthroplasty 19:157–161
Prasad N, Padmanabhan V, Mullaji A (2007) Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop 31:39–44
Raut VV, Stone MH, Wroblewski BM (1993) Reduction of postoperative blood loss after press-fit condylar knee arthroplasty with use of a femoral intramedullary plug. J Bone Joint Surg Am 75:1356–1357
Steffin B, Green-Riviere E, Giori NJ (2009) Timing of tourniquet release in total knee arthroplasty when using a postoperative blood salvage drain. J Arthroplasty 24:539–542
Tanaka N, Sakahashi H, Sato E, Hirose K, Isima T (2003) Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty 18:897–902
Vigano R, Whiteside LA, Roy M (2008) Clinical results of bone ingrowth TKA in patients with rheumatoid arthritis. Clin Orthop Relat Res 466:3071–3077
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Kilicarslan, K., Yalcin, N., Cicek, H. et al. The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study. Knee Surg Sports Traumatol Arthrosc 19, 932–935 (2011). https://doi.org/10.1007/s00167-010-1270-6
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DOI: https://doi.org/10.1007/s00167-010-1270-6