I see that the arthroscopic synovectomy gains in popularity nowadays. However, the idea of synovectomy in RA is to remove possibly the whole synovial membrane (total or subtotal synovectomy) so that the inflammatory process loses its ground. I wonder if this is possibly by means of arthroscopy ?
Thesis P.Tantschew: Die operative Synovektomie des Kniegelenkes bei...
Of course you can do it better by arthroscopy less morbidity and you can repeat the procedures many times and not doing it open to prevent scars and wound problem if one day the patient needs total knee replacement
I think by 2010 it is reasonable to say that nobody managing RA in the UK would consider any form of synovectomy appropriate. It is a systemic disease and we now have potent systemic drug therapies. Results from synovectomy were modest at best even in the 1970s. There are localised forms of synovitis in which synovectomy is sometimes useful partly as a diagnostic and partly as a local therapeutic option - as when excluding PVNS, but in RA this rarely if ever applies, even in monarticular cases.
Dear Dr. Edwards, I am sorry to hear that surgical synovectomy has no place in contemporary therapy modalities for RA. I would rather believe that in stubborn monoarticular or oligoarticular cases (which do not respond to systemic drug therapy) synovectomy (open or arthroscopic) gives reasonabable good results. By 2014 as well as in the 1970s.
I don't think we should be sorry that RA patients no longer need synovectomy. We have biologic drugs that will induce remission in almost all cases now. Orthopedic surgeons have proven that they have much more to offer than rheumatologists when it comes to solving problems of bone and cartilage but rheumatologists have now finally managed to deal with their side - the inflammation. Removing synovium is not a logical thing to do. It is replace by fibrous scar tissue and that often gives restriction of movement. The sensible approach is to remove the inflammation and leave the tissue intact.
Of course the drug therapies today are more efficient than those some 40 years ago in "almost all cases". Anyway, what about the rest of primary cases that do not respond positively.
Furthermore, I am sorry to state but I don't think the removed synovium is replaced by only fibrous scar tissue. In 2 months after subtotal synovectomy (which is the typical procedure) the synovium regenerates quite well. The only difference is that the regenerated synovial membrane is richer on fibrous elements and poorer on blood vessels. This fact is favorable as far as a renewed inflammation is expected. Of course during this period of regeneration an appropriate exercises program is administered to avoid restricted range of joint motion.
- Badges
- Science topic
- Similar topics
- Computer Communications (Networks)
- Simulators