Arthroscopic Synovectomy for the Rheumatoid Elbow: A Short-Term Follow-Up

Author(s): Nemoto K, Arino H, Yoshihara Y, Fujikawa K

Source: J Shoulder Elbow Surg 13(6):652-655, 2004

Summary:

This is a retrospective review of 10 patients with rheumatoid arthritis, all of whom had recurrent effusions and chronic synovitis of the elbow. There were 11 elbows in 10 patients: eight females and 2 males with a mean age of 54 years.  The authors performed arthroscopic synovectomy without resection of the radial head. The mean follow up period was 37 months.  The authors took pains to pre-operatively grade the extent of disease. The majority of patients were either Grade 3 or Grade 4 according to the scale by Larsen et al. Patients were asked to fill out a visual analog scales as well as an elbow evaluation and function score.  In addition, the authors evaluated the patients radiographically for evidence of progressive destruction.

Results demonstrated no progression in 8 of 11 patients at 37 months. Four of the joints had progressed one grade in the Larsen system. In addition, the visual analog scores improved significantly in all patients with a greater improvement being seen in the patients with more severe disease. This is in contrast to elbow range of motion, which improved more significantly in the patients with less advanced disease.

This study reflects the clinical experience in treating patients with arthroscopic synovectomy for rheumatoid disease. The procedure seems to be effective in relieving pain and improving function in most patients. The more advanced the disease and the more active the synovitis, the less likely that the procedure is going to result in improvement. It is significant that the patients did not undergo radial head excision even in advanced stages of the disease. It is possible that this might have resulted in some improvement in the overall arc of motion.  However, radial head excision in the rheumatoid elbow may lead to joint imbalance due to loss of a lateral joint stabilizer with subsequent progression of ulnohumeral arthrosis.   Finally, the operation requires a high degree of technical skill and experience, and it is not clear if arthroscopic synovectomy is superior to open synovectomy at long-term follow-up.

 

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