Arthroscopic Synovectomy of the Elbow in Rheumatoid Arthritis

Author(s): Horiuchi K, Momohara S, Tomatsu T, Inque K, Toyama Y

Source: J Bone Joint Surg 84-A:  342-347, 2002 


This study evaluates the long-term follow-up of arthroscopic synovectomy in elbows affected by rheumatoid arthritis.  Twenty-one elbows in 20 patients were followed for a minimum of 42 months.  The mean follow-up was 97 months.  All elbows were evaluated pre and post operatively with the Mayo elbow performance score and radiographic grading as described by Larsen et al.  The elbow performance score improved from 48 points pre-operatively to 78 points at 2 years follow-up.  At final evaluation the Mayo elbow performance score was 70 points.  The mean pain score improved from 9.3 points pre-operatively to 31.4 points at 2 years follow-up and 27.9 points at final evaluation.  Clinically apparent synovitis recurred in five of the twenty-one elbows and two of the five required total elbow arthroplasty.  There was no significant increase in range of motion following surgery, and there was a trend towards increased instability in all groups.  Three elbows had transient ulnar nerve paresthesias which all recovered within three months of the operative procedure. Elbow arthroscopic synovectomy in rheumatoid arthritis may be beneficial for earlier grades of arthritic changes as noted by the significant improvement in the elbow performance score and pain ratings.  Overall, there was no improvement in range of motion after arthroscopic synovectomy alone.  At long-term follow-up, a 24 percent recurrence of synovitis was noted.  This is consistent with reported results after open synovectomy.  There was a trend toward increased recurrence and decreased time until recurrence in patients treated without disease modifying anti-rheumatic drugs.  This highlights the importance of disease control in limiting further joint degeneration.  The study shows arthroscopic synovectomy to be an effective procedure in the rheumatoid elbow in experienced hands.  The main disadvantages of the arthroscopic approach are the greater degree of difficulty, the greater potential for neurologic injury and the retention of the radial head without enhanced forearm rotation.


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Journal of Bone and Joint Surgery