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Rheumatoid Synovectomy: Does the Surgical Approach Matter?

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Clinical Orthopaedics and Related Research®

Abstract

Background

Surgical synovectomy relieves pain in patients with rheumatoid arthritis (RA). The comparative effect of arthroscopic versus open synovectomy on pain reduction, recurrence of synovitis, radiographic progression, and need for subsequent total joint arthroplasty (TJA) is unclear. Whether synovectomy relieves pain in patients with advanced degenerative joint changes is also controversial.

Questions/purposes

We therefore asked whether arthroscopic synovectomy resulted in equal pain relief, recurrence rates, rates of radiographic progression, likelihood of arthroplasty, and whether surgical synovectomy relieved pain and halted progression in the presence of advanced RA.

Methods

We searched PubMed, Cochrane Database of Systematic Reviews, and BMJ Clinical Evidence. After appropriate selection criteria, 58 studies were identified, including 36 on open synovectomy and 22 on arthroscopic synovectomy, with a total of 2589 patients and a mean followup of 6.1 years. Meta-analysis was performed for knees and elbows, comparing open versus arthroscopic synovectomy. Variables included the percentage of patients with pain reduction, recurrence of synovitis, radiographic progression, and need for subsequent TJA or arthrodesis.

Results

Patients undergoing arthroscopic synovectomy had similar pain reduction, but more frequent recurrences of synovitis and radiographic progression than patients with open synovectomy. Patients undergoing arthroscopic synovectomy had similar and decreased risks of subsequent elbow and knee arthroplasties, respectively. Advanced preoperative radiographic RA did not correlate with worse pain scores nor increased need for subsequent arthroplasty when compared with minimal degenerative joint changes.

Conclusions

Arthroscopic synovectomy, while providing similar pain relief, may place patients at higher risk for recurrence and radiographic progression of RA. Advanced preoperative degenerative joint disease should not be an absolute contraindication to synovectomy.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Joseph Nguyen and Dr. Stephen Lyman for assistance in selecting appropriate statistical analyses.

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Authors and Affiliations

  1. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Peter N. Chalmers MD

  2. Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA

    Seth L. Sherman MD, Bradley S. Raphael MD & Edwin P. Su MD

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  1. Peter N. Chalmers MD
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  2. Seth L. Sherman MD
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  4. Edwin P. Su MD
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Correspondence to Edwin P. Su MD.

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Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

This work was performed at the College of Physicians and Surgeons at Columbia University in New York, NY and at the Hospital for Special Surgery in New York, NY.

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Chalmers, P.N., Sherman, S.L., Raphael, B.S. et al. Rheumatoid Synovectomy: Does the Surgical Approach Matter?. Clin Orthop Relat Res 469, 2062–2071 (2011). https://doi.org/10.1007/s11999-010-1744-3

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  • DOI: https://doi.org/10.1007/s11999-010-1744-3

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