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Arthroscopic and Open Synovectomy of the Elbow in Rheumatoid Arthritis
Nobuyuki Tanaka, MD1; Hisashi Sakahashi, MD1; Kazuya Hirose, MD1; Takumi Ishima, MD1; Seiichi Ishii, MD2
1 Sapporo Gorinbashi Orthopaedic Hospital, Gorinbashi Health Care Facilities and Hospitals, 2-1, Kawazoe, Minami-ku, Sapporo, Hokkaido 005-0802, Japan. E-mail address for N. Tanaka: nobuyuki.tanaka@ryumachi-jp.com
2 Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, South 1 West 17, Cyuou-ku, Sapporo 060-8543, Japan
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Sapporo Gorinbashi Orthopaedic Hospital, Gorinbashi Health Care Facilities and Hospitals, Sapporo, Hokkaido, Japan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(3):521-525. doi: 10.2106/JBJS.E.00472
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Background: Synovectomy has been advocated for early treatment of the rheumatoid elbow. It has not been determined whether arthroscopic or open synovectomy is better and whether a preoperative arc of flexion of >90° is an important prognostic factor.

Methods: Arthroscopic or open synovectomy was performed in fifty-eight elbows in fifty-three patients with rheumatoid arthritis and radiographic changes in the joint of Larsen grade 2 or less. Clinical symptoms, recurrent synovitis, postoperative complications, and radiographic changes were assessed ten to eighteen years (average, thirteen years) postoperatively.

Results: Eleven (48%) of twenty-three elbows in which arthroscopic synovectomy had been performed and sixteen (70%) of twenty-three elbows in which open synovectomy had been performed were mildly or not painful at the latest follow-up evaluation. However, no significant difference was detected between the overall clinical results of arthroscopic synovectomy and those of open synovectomy. In elbows with a preoperative arc of flexion of <90°, the clinical results of the two procedures were comparable. In elbows with a preoperative arc of flexion of <90°, arthroscopic synovectomy provided significantly (p < 0.05) better function than open surgery after mid-term follow-up, and motion and function continued to be better in those patients at the most recent follow-up evaluation. Recurrent synovitis was observed in six elbows that had arthroscopic synovectomy and in three that had open synovectomy, and the Larsen grade increased in both groups. Three elbows with a preoperative arc of flexion of <90° underwent a total elbow arthroplasty to treat ankylosis after open synovectomy. Surgical complications were uncommon and not severe.

Conclusions: Arthroscopic synovectomy of the elbow is a reliable procedure. One of the most favorable indications for either arthroscopic or open synovectomy is a preoperative arc of elbow flexion of =90° in patients with early rheumatoid arthritis.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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