Synovectomy Surgery

Overview and Procedure

Synovectomy is a surgical procedure that involves the removal of diseased synovial tissue, typically in joints affected by conditions like rheumatoid arthritis. By removing the inflamed synovium, the procedure helps reduce discomfort and cartilage loss, particularly when the joint is continuously inflamed. Synovectomy can significantly alleviate pain as long as the cartilage remains intact.

Alternate Name

Joint synovectomy

Synovectomy Procedure Types

Synovectomy can be performed using one of two main approaches: open surgery or arthroscopy. The choice of procedure depends on the individual case, and the surgeon will determine the most appropriate method.

Common Joints for Synovectomy

Synovectomy can be performed on various joints, including the:

  • Ankle
  • Knee
  • Shoulder
  • Wrist
  • Hip
  • Elbow

Preparation for Synovectomy Surgery

Before undergoing synovectomy, a thorough evaluation is performed to assess the condition and determine the suitability of surgery:

  • Health Assessment: A comprehensive medical history is taken, and a physical examination of the affected joint is conducted to evaluate the extent of the injury, pain, and flexibility.
  • Imaging Investigations: To better understand the condition and confirm the diagnosis, various imaging techniques may be used:
    • X-ray: A common and accessible method to capture images of the joint.
    • MRI: Provides detailed images of the joints, often used to assess soft tissue damage.
    • Ultrasonography: A probe is moved over the skin to examine the connective tissues in the joint.
    • Scintigraphy: A radiotracer is administered to identify abnormal areas in the joint, followed by imaging with specialized equipment.

Pre-Surgery Tests:
Routine tests are performed before surgery, which may include:

  • Platelet count and hemoglobin analysis
  • Bleeding and clotting time
  • Viral screening
  • Blood type and group
  • Urine test
  • Kidney and liver function tests
  • Chest X-ray
  • Electrocardiogram

How Synovectomy Surgery is Performed

Synovectomy is typically performed in one of two ways:

  1. Open Synovectomy:
    • A skin incision is made near the joint, and soft tissues are carefully dissected.
    • The abnormal synovial membrane is identified and removed.
    • Any debris, loose bodies, and fibrous tissue are cleared.
    • The incision is then closed with stitches.
  2. Arthroscopic Synovectomy:
    • Several small incisions are made around the joint.
    • An arthroscope (a small tube with a camera) is inserted into one incision, providing a view of the joint on a screen.
    • Small surgical instruments are inserted through the other incisions to remove the affected synovium.
    • Electrocautery is used to control bleeding during the procedure.
    • After the synovectomy, the incisions are closed with stitches, and a compressive dressing is applied.

Arthroscopic synovectomies are more common, and in some cases, repeat procedures may be needed to manage ongoing disease.

Post-Surgery Follow-Up

After surgery, follow-up appointments are necessary to monitor recovery. The first visit is typically scheduled within 7 to 10 days to remove stitches and assess joint healing.

  • For knee synovectomy, a removable cast is applied to immobilize the knee, and physiotherapy usually begins one or two days post-surgery.
  • A vacuum drain is often removed 24 hours after surgery to prevent fluid buildup.

Recovery:

  • Physical therapy is important to address any stiffness and improve range of motion.
  • Most patients experience significant relief and improved joint function, especially when the articular cartilage remains intact.
  • Regular check-ups are essential to monitor progress and address any concerns.

Risks and Complications of Synovectomy

As with any surgery, synovectomy carries certain risks, including:

  • Knee wound complications such as bleeding.
  • Damage to tendons, ligaments, or cartilage in the knee.
  • Formation of blood clots in the leg.
  • Injury to nerves or blood vessels.
  • Joint inflammation.
  • Post-operative stiffness, especially after open surgery.

Recovery and Rehabilitation

Recovery time varies depending on the joint and extent of the surgery. Range-of-motion exercises are critical, particularly for larger joints like the knee.

  • Constant Passive Motion (CPM): A CPM device may be used shortly after surgery to maintain joint mobility.
  • Physical Therapy: Rehabilitation typically begins within one or two days to restore joint function. Working with a skilled therapist is essential for recovery.
  • Medications: Post-surgery medications help manage pain and prevent further joint damage or synovial inflammation.

In most cases, recovery is successful, with many patients experiencing reduced pain and improved mobility in the affected joint.