Synovectomy of the Knee in Rheumatoid Arthritis

Se II Suk; Moon Sang Chung; Ki Ser Kang

doi:10.4055/jkoa.1975.10.4.456

Journal List > J Korean Orthop Assoc > v.10(4) > 1143666

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Suk, Chung, and Kang: Synovectomy of the Knee in Rheumatoid Arthritis

Original Article

J Korean Orthop Assoc 1975;10(4):456-460.

Published online: 20 December 1975

DOI: https://doi.org/10.4055/jkoa.1975.10.4.456

Synovectomy of the Knee in Rheumatoid Arthritis

Se II Suk, M.D., Moon Sang Chung, M.D., Ki Ser Kang, M.D.

¹Department of Orthopzedic Surgery, College of Medicine, Seoul National University

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

1. Forty seven patients were admitted in Department of Orthopedic Surgery at Seoul National University Hospital with rheumatoid knee. 25 patients were treated conservatively and synovectomies were performed in 18 knees.

2. Septic knees complicating rheumatoid arthritis were observed in 7 cases. Chance of the septic knee was significantly enhanced in a patient who had a long history of steroid administration, acupuncture and moxacautery.

3. Local inflammatory reaction with steroid crystals were found in 3 patients among 11 patients who had intraarticular steroid injection.

4. Post-synovectomy pain relief was obtained in most of the patients, but range of motion was increased in only 16.5% and decreased in 55. 5%.

5. Better results of synovectomy could be expected if the disease in the knee is not advanced at the time of synovectomy.

REFERENCES

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2.Conaty J. P.Surgery of the Hip and Knee in Patient with Rheumatoid Arthritis. Journal of Bone end Joint Surgery. 55-A:301–314. 1973.

3.Geens S.Synovectomy and Debridement of the Knee in Rheumatoid Arthritis, Pert I Historical Review. Journal of Bone and Joint Surgery. 51-A:617–625. 1969.

4.Geens S.., Clayton M. L.., Leidholt J. D.., Smyth C. H.., Bartholomew B. A.Synovectomy end Debridement of the Knee in Rheumatoid Arthritis, Part II Clinical end Radiological Study of 31 Cases. Journal of Bone and Joint Surgery. 51-A:626–642. 1969.

5.Graham J.., Checketts R. G.Synovectomy of the Knee Joint in Rheumatoid Arthritis. Journal of Bone and Joint Surgery. 55-B:786–795. 1973.

6.Gristina A. G.., Rovere G. D.., Shoji H.Spontaneous Septic Arthritis Complicating Rheumatoid Arthritis. Journal of Bone and Joint Surgery. 56-A:1180–1184. 1974.

7.Hasting D. E.., Hewitson W. H.Double Hemiarthroplasty of the Knee in Rheumatoid Arthritis A Servey of Fifty Consecutive Cases. Journal of Bone and Joint Surgery, 55-B titilé. 1973.

8.Kahn C. B.., Hollander J. L.., Schumacher H. R.Corticosteroid Crystals in Synovial Fluid. JAMA. 211-S:307S09. 1970.

9.Laurin C. A.Synovectomy of the Knee in Rheumatoid Arthritis. Clin. Orthopedics. 101:36–39. 1974.

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Chart.

1 Age and Sex Incidence

Photo 1.

Steroid granuloma

Table I.

Notable previous treatment

	Number of patients	Oral steroid	Local steroid	Acupuncture	Moxacautery
Non- infected	40	11 (28%)	7 (18)	9 (23)	5 (13)
Infected	7	3 (43%)	4 (57)	4 (57)	2 (29)
Total	47	14 (30%)	11 (23)	13 (28)	7 (15)

Table II.

Complications of intraarticular steroid injection

Complication	Number of cases	%
Number of knee injected	11	100
Infection	4	36
Precipitates observed	3	27

Table III.

Laboratory findings

	Non-infected (40 patients)	Infected (7 patients)
Hb	12.6	11.0·
WBC	8200	9300
Poly	66%	69%
ESR	26	28
R. A test(+)	70%	72%
Pus culture	—	Staphylococcus	6
		E. Coli	1

Table IV.

Table Treatment

Treatment	Number of patients	%
Conservative only	25	53.2
Synovectomy	16	34. α
Fusion	3	6.4
Osteotomy	2	4.3
Arthroplasty	1	2.1
Total	47	100

Table V.

Pain after synovectomy

Pain	Number of knees		%
Improved	17		94
No pain		11		61
Occasionally felt		4		22
Frequently felt but improved		2		11
Not improved	1		6
Total	18		100

Table VI.

Range of motion after synovectomy

	Number of knees	%
Increased	3	16.5
No. change	5	28.0
Decreased	7	39.0
Markedly decreased	3	16-5
Total	18	100

Table VIII.

Correlation between severity of the disease and result

		Result				% Good and satisfactory
Stage of disease	Number of knees	Good	Satisfactory	Fair	Poor	% Good and satisfactory
I	2	1	1	0	0	100
II	7	2	3	2	0	71
I	6	0	4	1	1	67
IV	3	0	0	2	1	0
Total	18	3	8	5	2	61

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