Synovectomy for Rheumatoid Arthritis

Overview

The synovium is a very thin layer of cells that lines each joint. In rheumatoid arthritis (RA), the synovium can become inflamed, causing overgrowth, pain and swelling. In turn, the inflamed synovium can damage the bone and cartilage of the joint. In severe cases, when medication cannot control the inflammation, pain can make it impossible to function.

Synovectomy is surgery to remove the inflamed synovium from a joint. In people with rheumatoid arthritis, synovectomy is most frequently performed on the wrists and knees. Synovectomy may also be performed on ankles, elbows, finger joints, hips, and shoulders. Synovectomy can relieve pain and restore function.

Synovectomy is not recommended once the cartilage in a joint has become damaged. For this reason, it is most often performed on people who are in the earlier stages of RA. Surgery is not usually considered until after medications have been tried for six to 12 months.

Synovectomy is not a cure for RA, and it does not prevent future disease activity. The synovium in the affected joint may grow back, requiring additional surgeries.

What does it involve?
Your doctor may order a complete physical, blood tests, or other diagnostic procedures to ensure that you are in good condition for surgery.

Once your synovectomy is scheduled, spend the weeks before surgery preparing by eating nutritious meals and staying as active as possible. Stop or cut down your smoking, and limit your consumption of alcoholic beverages to one or two per day. Being in top condition for surgery will shorten your recovery time and help prevent complications.

You will be given instructions to stop eating several hours before surgery. When you arrive at the hospital, vital signs will be taken, and blood may be drawn. Before surgery, you will receive an intravenous (IV) line. Depending on the type of tendon repair you are receiving, you may receive medication to relax you, but remain awake during surgery, or general anesthesia to make you sleep.

Synovectomy is most frequently performed using an arthroscopic technique. Arthroscopy is minimally invasive surgery that involves making five or six small incisions and inserting tiny tools to shave off portions of inflamed synovium. Synovectomy may also be performed via traditional open surgery. Depending on which joint is undergoing surgery, the surgeon may place a temporary drain in the surgical site before closing the wound.

Depending on your condition and the surgical technique used, you may spend one or more nights in the hospital recovering. The nurse or doctor will explain how to care for your wound. You will begin rehabilitation exercises early in recovery. Completing your rehabilitation program is key to a successful joint surgery.

Your joint may be immobilized by a cast for some time after synovectomy. Ask your doctor how recovery will impact your daily functions, and for how long. Consider asking a relative, friend, or neighbor to help you during this time, or hiring a home care provider if you will need assistance.

Intended Outcomes
Synovectomy can reduce pain and restore function, making it possible to return to performing normal daily tasks.

Results
Postoperative studies have shown that synovectomy can significantly improve pain and function over preoperative measurements.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

Synovectomy can be painful, and you will most likely need pain medication for a few days during recovery.

Even if your synovectomy is successful, you may need future surgery on the same joint.

Call your doctor immediately if you notice signs of infection such as swelling, redness, increased pain, or bleeding from the surgical wound.