COMBINED ARTHROSCOPIC AND RADIATION SYNOV ECTOMY IN RHEUMATOID-ARTHRITIS

In rheumatoid arthritis of the knee joint good results are obtained us ing arthroscopic synovectomy or radiation synovectomy. Aim of our stud y was to investigate, wether the combination of these two minimal inva sive interventions achieves better results. First we performed arthros copic synovectomy of the knee joint followed by radiation synovectomy with application of 111-222 MBq Yttrium-90 6 weeks later. In a prospec tive randomised clinical trial between 1987 and 1991 we performed radi ation synovectomy on 22 knee joints and combined arthroscopic and radi ation synovectomy on 26 knee joints. We explored the patients preopera tively, 6 weeks and 6 months postoperatively. In 1996 we evaluated 141 knee joints in a retrospective clinical trial. 90 Knee joints had bee n treated with the combined therapy, 39 only with radiation synovectom y and 12 only with arthroscopic synovectomy. Depending on the three di fferent therapeutic interventions, the patients were classified into m idterm (3-5 years) and long-term (6-8 years) observation groups. The t rials are based on the standardized ARO-Questionnaire of the knee join t, the modified ARO Knee-Score and the radiological grading according to Larsen, Dale and Eek. In the prospective clinical trial we found si gnificant better results for patients treated with the combined therap y than for patients treated with radiation synovectomy only regarding the parameter swelling, effusion, range of motion, pain and Knee-Score . In the long-term results of the retrospective clinical trial the pat ients treated with the combined therapy showed a significant better ou tcome for the parameters pain, swelling and Knee-Score, than the patie nts treated with radiation synovectomy. Although no statistically sign ificant difference was found comparing the results of the combined the rapy with arthroscopic synovectomy, an improvement of the clinical out come can be observed performing arthroscopic synovectomy followed by r adiation synovectomy. In the treatment of rheumatoid arthritis of the knee joint a better outcome is achieved performing combined arthroscop ic and radiation synovectomy than performing only one of the methods.