What is a Synovectomy?

A synovectomy is a surgical procedure for those suffering from significant pain and loss of function due to rheumatoid arthritis. This surgery is usually performed with an arthroscope, a thin, lighted tube attached to a television screen which is inserted through a small incision in the affected area. This procedure, though not a cure, can increase function and decrease pain.

Rheumatoid arthritis (RA) is a form of inflammatory arthritis that affects the synovium, or the lining of the joints. The synovium acts as a filter to clear debris and infections. Inflammation of this lining causes it to become clogged, making it very thick and swollen often impeding normal, pain-free motion.

Symptoms of RA include joint pain, tenderness and swelling, morning stiffness and fatigue, and occasionally weight loss and fever. Rheumatoid nodules, or firm bumps under the skin, a sign of joint deformity, may also appear. Typically, RA affects the smaller joints first and can occur in several joints simultaneously. Over time, RA can cause damage to the joints, cartilage, ligaments, tendons and bone.

Once diagnosed with RA, through a detailed medical history, blood tests, x-rays and joint fluid analysis, conservative treatment options such as nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), regular exercises and coping strategies, such as heat or cold application and rethinking daily activity strategies, is recommended. If, after six to twelve months, symptoms become worse, a synovectomy may be an option.

A synovectomy removes inflamed joint tissue causing the pain and dysfunction, and can decrease swelling and slow bone damage and erosion. Common areas for a synovectomy are the knees, shoulders, wrists, elbows, fingers and hips. But, as with any surgical procedure, it comes with its fair share of risks. Depending on the severity and location, a local or general anesthesia is necessary. There is the possibility of infection, bleeding into the joint area and possible loss of joint motion post surgery.

After a synovectomy, a brief time of immobilization is followed by movement, typically through the use of a continuous passive motion machine (CPM). The use of pain medications to deal with post-surgical pain, and physical therapy are the recommended courses of action. Physical therapy consists of range of motion exercises and general strengthening, essential to regaining function. Antibiotics also may be used to ward off infection.

A synovectomy is most beneficial to joints with minimal damage and is a useful early treatment option. But though it may only provide temporary relief of symptoms, if left untreated, rheumatoid arthritis can lead to complete destruction of the joint. By removing the inflamed tissue, a synovectomy can delay or stop the necessity of a total joint replacement.