What is Synovectomy?

Synovectomy is the surgical removal of diseased synovium and is a palliative treatment for severe rheumatoid arthritis.

Effects of Synovectomy

Synovectomy is effective in the treatment of joints affected by rheumatoid arthritis that have minimal bone or cartilage destruction when medication has not alleviated pain. Synovectomy may decrease swelling, decelerate cartilage loss and bone erosion, and ease pain. Synovectomy does not treat the disease, but it may temporarily relieve symptoms.

Candidates for Synovectomy

Ideal candidates for synovectomy are those who have chronic inflammatory arthritides (rheumatoid arthritis, psoriatic arthritis), benign neoplastic disorders (osteochondromatosis and pigmented villonodular synovitis), and recurrent hemarthrosis (hemophilia).

Your Consultation

Prior to the procedure, the doctor will perform a complete medical examination. The doctor may also need to be certain that you do not have any infections, such as a urinary tract infection or an abscessed tooth. Additionally, you will need to discontinue taking anti-inflammatory drugs no less than a week prior to the surgery. This is because anti-inflammatory drugs escalate the risk of bleeding and infection. Your doctor may also order x-rays or an MRI to look at the joint prior to surgery.

The Synovectomy Procedure

Initially, you will be given either a local or general anesthetic, depending on your situation and doctor’s recommendation. During the procedure, the surgeon will penetrate the joint via a small incision with an arthroscope, a narrow tube with a light at the end of it that is attached to a television. The arthroscope permits the doctor to see inside the joint and get rid of diseased tissue. The surgeon’s team may pump a sterile saline solution into the joint in order to clean it. Air may also be pumped in to inflate the joint space, allowing the surgeon to see inside the joint without difficulty. By means of the arthroscope, the surgeon will get rid of the diseased synovium with small surgical tools and suction equipment. While inside the joint, the surgeon will also inspect for any other problems such as additional damage to the tissues or cartilage and floating pieces of debris.

Recovery

You can begin moving the joint with support from a physical therapist after about 4 to 14 days from surgery. Recovery depends on the surgical technique applied and the site of the incisions. After knee synovectomy, your knee will be immobilized in a detachable cast, and physical therapy is initiated after 1 to 2 days.

Risks

As with any other surgery, possible complications from synovectomy include risks of surgery and using anesthesia, as well as a minor risk of infection and bleeding within the joint. It is also probable that there may be a loss in the range of motion of the joint, or recurrence of inflammation.

FAQs

Why is synovectomy done?

Synovectomy surgery is performed to get rid of inflamed joint tissue (synovium) that is producing intolerable pain or is restraining your ability to function or your range of motion. In the procedure, ligaments and other structures may be moved to one side to access and remove the inflamed joint lining.

What are the advantages and disadvantages of synovectomy?

One of the advantages of this surgery is that it can relieve rheumatoid arthritis pain in the joints by taking away diseased tissue. Also, the joint may be saved from further damage. But this is not a permanent solution in most cases since the synovium can grow back over time. Be certain to discuss with your doctor the benefits and drawbacks of this surgery in your specific case.

What can I expect after the surgery?

A synovectomy demands you to go through physical therapy and use medications for pain management. Immediately after the surgery, you will probably have a sling, if it was your shoulder, wrist or elbow that was operated on; or a splint or brace if it was your knee. If you have a sling, it may be taken off for periods of time as the healing takes place. Antibiotics may be prescribed to prevent infection and/or pain medications.

Are there complications in this procedure?

There are potential complications with synovectomy. It is possible that the synovium may grow back, and in rare cases, you may get a blood clot. Also, some people may have an adverse reaction to the anesthesia. Be sure to inform your doctor if you experience any increase in pain or swelling after you go home and if you are losing range of motion. An infection may have set in if you feel very tired or have a fever.