Synovectomy in rheumatoid arthritis has been shown to relieve pain and preserve joint function. Open synovectomy has complications including stiffness and wound care. This study reports the results of arthroscopic synovectomy of the wrist in patients with rheumatoid arthritis. Eighteen patients and 19 wrists were included in the study. All patients were on oral medications to control rheumatoid arthritis. All patients had pain and dysfunction of the wrist that did not respond to systemic treatment for six months. All patients had some maintenance of joint space and mean follow-up was 29 months. The technique consisted of synovectomy of the radiocarpal and mid-carpal joints. If there was disruption of the triangular fibrocartilage, then the distal radioulnar joint could be reached from the radiocarpal joint. Otherwise, separate portals were used for distal radioulnar joint synovectomy. Active motion was started two to three days after surgery.
Patients were assessed before and after the operation using a variety of scales. All patients experienced a reduction in pain, except for two who underwent repeat surgery for persistent pain and progression of radiographic changes. The initial pain reduction diminished somewhat at longer follow-up. However, persistent pain relief remained evident as did patient’s satisfaction at follow-up examination. Four of the 19 patients showed progressive degenerative changes after synovectomy.
Arthroscopic synovectomy may be considered a treatment option for patient with rheumatoid arthritis and recalcitrant synovitis. Additional portals may be required to obtain adequate removal of the synovium. The procedure is primarily indicated for patients in the early stage of rheumatoid involvement without considerable degenerative joint changes. The main limitation of this study is the short-term follow-up. Long-term follow-up is necessary to assess whether synovectomy changes the natural history.
J Bone Joint Surg