Synovectomy surgery is done to remove inflamed joint tissue (synovium) that is causing unacceptable pain or is limiting your ability to function or your range of motion. Ligaments and other structures may be moved aside to access and remove the inflamed joint lining. The procedure may be done using arthroscopy. Synovectomy may be used to treat joints affected by rheumatoid arthritis that have minimal bone or cartilage destruction when medicine has not relieved pain. Synovectomy may be considered if significant pain persists after 6 to 12 months of drug treatment including the use of disease-modifying antirheumatic drugs (DMARDs).
Local, regional, or general anesthesia is used depending on the location of the joint, amount of synovium to be removed and the technique employed. The procedure can be performed in an outpatient or inpatient setting depending on the technique. More often for larger joints (i.e., knee, shoulder, hip) and increasingly for smaller joints, a Synovectomy has performed arthroscopically. A thin, fiberoptic surgical and viewing instrument (arthroscope) is inserted into the joint space through a small skin incision to visualize the interior of the joint. Instruments are then inserted into the joint through 4 or 5 other tiny incisions (portals) to cut away the synovium. An irrigation solution is infused into the joint to help clear the area of debris created during the procedure. The arthroscopic approach is generally minimally invasive and requires only a few small incisions. Consequently, less tissue trauma may be associated with arthroscopic surgery than with open surgery. For larger joints, this may result in a shorter hospital stay, reduced postoperative joint stiffness and a complete Synovectomy. After the surgery, a pressure dressing is applied and the joint is kept mobile to inhibit scarring. In an open procedure the joint capsule is exposed through an incision over the affected joint (arthrotomy). The synovium is identified and removed by cutting. A soft pressure dressing is applied to control swelling. Early limited joint motion is encouraged to prevent scar tissue (adhesions) from forming in the joint that would limit the range of motion.
Rehabilitation & Recovery
The goal of rehabilitation after synovectomy is to decrease pain and to restore function. The intensity and duration of rehabilitation depend on the underlying condition, the involved body part, and the preoperative functional status of the individual. Modalities such as heat and cold are used to control pain and swelling (Braddom). If the lower extremity is involved, assistive devices may be used to promote independent ambulation, although typically weight bearing is not limited. Individuals may be instructed in a gentle range of motion and strengthening exercises to be continued independently in order to preserve joint mobility and function. Limited supervised rehabilitation is indicated in most cases. Prior to discharge from therapy, individuals should be educated in ways to protect the involved joint and in self-care, including a home exercise program. If impaired function persists, modifications in lifestyle and the workplace may be recommended by an occupational therapist or ergonomist (Firestein).