ARTHROSCOPY-ASSISTED SYNOVECTOMY IN THE TREATMENT OF CHRONIC SYNOVITIS OF THE KNEE

The place of arthroscopy-assisted synovectomy in the treatment of infl ammatory synovitis of the knee was evaluated by studying 26 patients w ho underwent this procedure between November 1992 and September 1995. Half the patients had rheumatoid arthritis. Twenty-three patients (28 knees) were reevaluated after a mean follow-up of 32 months (range, 4- 50 months). The arthroscopic synovectomy was done either as the first- line synovectomy procedure, after failure of triamcinolone hexacetonid e injection into the joint, or as the second-line synovectomy procedur e, after failure of osmic acid or yttrium-90 synovectomy. Except in on e patient with severe arthritis, arthroscopic synovectomy produced sta tistically significant improvements regarding pain (visual scale), fun ction (Lequesne's index), range of flexion, amount of joint fluid and knee circumference. The range of extension of the knee was normal at b aseline and remained so after the procedure. Overall efficacy was simi lar for first-line and second-line procedures. Results were rated good to very good by 71% of the patients and 61% of the physicians overall and the overall improvement in knee arthritis as perceived by the pat ients was 60%. The procedure was well tolerated in 93% of cases. The m ean time needed to achieve a stable improvement was 3.2 creeks for pai n, 4.7 weeks for swelling and 3.6 weeks for range of motion. One case each of hemarthrosis and stiffness of the knee were recorded, with a f ull recovery in both cases. Arthroscopic synovectomy is effective and safe but more burdensome and expensive than osmic acid or radiation sy novectomy, and consequently deserves a place of choice in patients who have failed to respond to either of the last two methods.