Elbow Synovectomy on Patients with Juvenile Rheumatoid Arthritis

Author(s): Maenpaa H, Kuusela P, Lehtinen J, Savolaonene A, Kautiainen H, Belt E

Source: Clinical Orthopaedics and Related Research 412; 65-70, 2003.

Summary:

This study reports on the results of 24 primary open elbow synovectomies performed on 19 patients with a mean age of 29 years (range, 1-64 years). Most patients had minimal preoperative radiographic destruction as evidenced by 21% Larson grade 0, 21% grade 1, 54% grade 2, 4% grade 3 and 0% grade 5.  Preoperative range of motion averaged 24 degrees short of full extension and 133 degrees of flexion.  Forearm pronation averaged 80 degrees with supination 79 degrees.  All elbows had been injected with glucocorticoids an average of 4 times preoperatively.  All procedures were performed open through a posteroradial exposure.  The radial head was excised in 4 patients with a significant destruction or subluxation, and the anterior capsule was released in 2 patients with significant extension deficit.  The cumalative survival rate was 84% at 5 years, which was defined as repear synovectomy, elbow arthroplasty or death as an endpoint.  Four elbows underwent repeat synovectomy, and 2 elbow replacements were performed.  Fourty-four percent of patients reported complete pain relief and subjective outcome was good or excellent in 72% of the patients.  Range of motion was not significantly improved.  There was 1 superficial wound infection and 1 worsened contracture.

This article was only the second report outlining the results of elbow synovectomy in juvenile rheumatoid arthritis patients.  The results support a reasonable 5-year benefit with high patient satisfaction and a low complication rate.  However, only 44% of patients reported complete pain relief, which is less than those reported in general rheumatoid arthritis patients.  This article supports the efficacious use of synovectomies in juvenile rheumatoid arthritis patients.  Most patients have mild destructive changes and the radial was generally retained. 

Related Links

Clinical Orthopaedics and Related Research 412; 65-70, 2003.