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)
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.