Synovectomy

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Synovectomy
ICD-9-CM 80.7

Synovectomy is a procedure where the synovial tissue surrounding a joint is removed. This procedure is typically recommended to provide relief from a condition in which the synovial membrane or the joint lining becomes inflamed and irritated and is not controlled by medication alone. If arthritis (inflammation of the joint) is not controlled, it can lead to irreversible joint damage. The synovial membrane or "synovium" encloses each joint and also secretes a lubricating fluid that allows different joint motions such as rolling, folding and stretching. When the synovium becomes inflamed or irritated, it increases fluid production, resulting in warmth, tenderness, and swelling in and around the joint.

Contents

A synovectomy is a procedure often suggested for those with rheumatoid arthritis or other forms of inflammatory arthritis when non-operative treatments have failed. This procedure can be performed in several ways, namely surgical synovectomy, chemical synovectomy and radiological.

The surgical procedure can be performed arthroscopically [1] or by opening the joint to remove the synovial tissue surrounding the joint that has become inflamed and swollen. Chemical Synovectomy involves an intraarticular osmic acid injection with the objective to debulk or reduce the inflammatory synovial mass.

Indications

Synovectomy is indicated in following conditions:

Synovectomy is to be performed before cartilage damage has occurred. Conditions, where Synovectomy can provide some relief, are listed below.

Pigmented villonodular synovitis (PVNS)

PVNS (Pigmented villonodular synovitis): is a joint problem that usually affects the shoulder, hip or knee. It can also affect the elbow, ankle, and hand or foot. In pigmented villonodular synovitis, the synovial joint lining becomes swollen and grows. It may harm the bone around the joint. The lining also makes extra fluid that can cause swelling and make movement difficult and painful.

Rheumatoid arthritis (RA)

Rheumatoid arthritis is a (chronic) long-term disease that causes pain, stiffness, swelling, decreases the range of motion of many joints. It affects any joint in the body commonly hands, knees, wrists, shoulder, elbow, hips, feet.

In rheumatoid arthritis (RA) the synovial membrane becomes inflamed, it can become edematous and thicken with inflammatory exudates. Moreover, similar conditions can also be seen in juvenile rheumatoid arthritis and psoriatic arthritis. Synovectomy for RA [2] has become relatively rare because nowadays patients with Rheumatoid Arthritis [3] have access to disease modifying drugs called biologics that are effective in containing the inflammation that damages the synovial tissue. In cases when the patient undergoes a rapid deterioration of joints, physicians lean towards a total knee replacement as the last recourse option. Still, in select cases where the patient is resistant to biologics as well as have higher risk factors for a TKR, synovectomy can still be looked into to provide some relief ranging anywhere from a one-year to three-year period. A study that analyzed patients who underwent Osmic Acid Synovectomy found that approximately 28% patients were in disease remission for their knee joint for over three years duration. [4]

Variants

Synoviorthesis, or medical synovectomy, may be achieved with the intra-articular injection of several substances: [5]

See also

Related Research Articles

<span class="mw-page-title-main">Arthritis</span> Type of joint disorder

Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden.

<span class="mw-page-title-main">Rheumatoid arthritis</span> Type of autoimmune arthritis

Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body, including skin, eyes, lungs, heart, nerves and blood. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.

<span class="mw-page-title-main">Synovial membrane</span> Connective tissue present within and around synovial joints

The synovial membrane is a specialized connective tissue that lines the inner surface of capsules of synovial joints and tendon sheath. It makes direct contact with the fibrous membrane on the outside surface and with the synovial fluid lubricant on the inside surface. In contact with the synovial fluid at the tissue surface are many rounded macrophage-like synovial cells and also type B cells, which are also known as fibroblast-like synoviocytes (FLS). Type A cells maintain the synovial fluid by removing wear-and-tear debris. As for the FLS, they produce hyaluronan, as well as other extracellular components in the synovial fluid.

<span class="mw-page-title-main">Septic arthritis</span> Medical condition

Acute septic arthritis, infectious arthritis, suppurative arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved, especially in neonates, younger children and immunocompromised individuals. In neonates, infants during the first year of life, and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.

<span class="mw-page-title-main">Bursitis</span> Human disease

Bursitis is the inflammation of one or more bursae of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying on the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

<span class="mw-page-title-main">Baker's cyst</span> Medical condition

A Baker's cyst, also known as a popliteal cyst, is a type of fluid collection behind the knee. Often there are no symptoms. If symptoms do occur these may include swelling and pain behind the knee, or knee stiffness. If the cyst breaks open, pain may significantly increase with swelling of the calf. Rarely complications such as deep vein thrombosis, peripheral neuropathy, ischemia, or compartment syndrome may occur.

<span class="mw-page-title-main">Synovial fluid</span> Fluid found in the cavities of synovial joints

Synovial fluid, also called synovia,[help 1] is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its egg white–like consistency, the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement. Synovial fluid is a small component of the transcellular fluid component of extracellular fluid.

<span class="mw-page-title-main">Bog spavin</span>

Bog spavin is a swelling of the tibiotarsal joint of the horse's hock which, in itself, does not cause lameness. The joint becomes distended by excess synovial fluid and/or thickened synovial tissue bringing about a soft, fluctuant swelling on the front of the joint, as well as in the medial and lateral plantar pouches. Bog spavin is generally an indication of underlying pathology within the joint.

<span class="mw-page-title-main">Synovial osteochondromatosis</span> Medical condition

Synovial osteochondromatosis (SOC) is a rare disease that creates a benign change or proliferation in the synovium or joint-lining tissue, which changes to form bone-forming cartilage. In most occurrences, there is only one joint affected, either the knee, the hip, or the elbow. Rarely involves the TMJ.

<span class="mw-page-title-main">Synovitis</span> Medical condition

Synovitis is the medical term for inflammation of the synovial membrane. This membrane lines joints that possess cavities, known as synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to synovial fluid collection.

Arthroscopic lavage is the washing out or cleaning out the contents inside a joint space. Lavage is a general term referring to the therapeutic washing, cleaning or rinsing.

<span class="mw-page-title-main">Synovial chondromatosis</span> Medical condition

Synovial chondromatosis is a locally aggressive bone tumor of the cartilaginous type. It consists of several hyaline cartilaginous nodules and has the potential of becoming cancerous.

Palindromic rheumatism (PR) is a syndrome characterised by recurrent, self-resolving inflammatory attacks in and around the joints, consists of arthritis or periarticular soft tissue inflammation. The course is often acute onset, with sudden and rapidly developing attacks or flares. There is pain, redness, swelling, and disability of one or multiple joints. The interval between recurrent palindromic attacks and the length of an attack is extremely variable from few hours to days. Attacks may become more frequent with time but there is no joint damage after attacks. It is thought to be an autoimmune disease, possibly an abortive form of rheumatoid arthritis.

<span class="mw-page-title-main">Knee effusion</span> Medical condition

Knee effusion, informally known as water on the knee, occurs when excess synovial fluid accumulates in or around the knee joint. It has many common causes, including arthritis, injury to the ligaments or meniscus, or fluid collecting in the bursa, a condition known as prepatellar bursitis.

<span class="mw-page-title-main">Rheumatoid nodule</span> Medical condition

A rheumatoid nodule is a lump of tissue, or an area of swelling, that appear on the exterior of the skin usually around the olecranon or the interphalangeal joints, but can appear in other areas. There are four different types of rheumatoid nodules: subcutaneous rheumatoid nodules, cardiac nodules, pulmonary nodules, and central nervous systems nodules. These nodules occur almost exclusively in association with rheumatoid arthritis. Very rarely do rheumatoid nodules occur as rheumatoid nodulosis in the absence of rheumatoid arthritis. Rheumatoid nodules can also appear in other areas of the body other than the skin. Less commonly they occur in the lining of the lung or other internal organs. The occurrence of nodules in the lung of miners exposed to silica dust was known as Caplan’s syndrome. Rarely, the nodules occur at diverse sites on body.

Remitting seronegative symmetrical synovitis with pitting edema (or sometimes RS3PE) is a rare syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema (swelling) of the back of the hands and/or feet, and a negative serum rheumatoid factor. If no underlying disorder can be identified (idiopathic RS3PE), this entity has an excellent prognosis and responds well to treatment.

Fibroblast-like synoviocytes (FLS) represent a specialised cell type located inside joints in the synovium. These cells play a crucial role in the pathogenesis of chronic inflammatory diseases, such as rheumatoid arthritis.

<span class="mw-page-title-main">Intermittent hydrarthrosis</span> Medical condition

Intermittent hydrarthrosis (IH), also known as periodic synoviosis, periodic benign synovitis, or periodic hydrarthritis, is a chronic condition of unknown cause characterized by recurring, temporary episodes of fluid accumulation (effusion) in the knee. While the knee is mainly involved, occasionally other joints such as the elbow or ankle can additionally be affected. Fluid accumulation in the joint can be extensive causing discomfort and impairing movement, although affected joints are not usually very painful. While the condition is chronic, it does not appear to progress to more destructive damage of the joint. It seems to affect slightly more women than men.

<span class="mw-page-title-main">Tenosynovial giant cell tumor</span> Human joint disease

Tenosynovial giant cell tumor (TGCT) is a group of rare, typically non-malignant tumors of the joints. TGCT tumors often develop from the lining of joints.

References

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  2. Mongan, Edward S.; Boger, William M.; Gilliland, Bruce C.; Meyerowitz, Sanford (Nov 1, 1970). "Synovectomy in rheumatoid arthritis". Arthritis & Rheumatology. 13 (6): 761–768. doi: 10.1002/art.1780130605 . PMID   5495388.
  3. "Rheumatoid Arthritis | Rheumatoid Arthritis Treatment - Healthclues".
  4. Gleb, Slobodin; Itzhak, Rosner; Nina, Boulman; Michael, Rozenbaum (Jan 1, 2008). "Osmic acid synovectomy in the era of biologics". Rheumatology International. 28 (3).
  5. Hochberg Marc C., Silman Alan J. CHAPTER 40: Aspiration and injection of joints.../Synoviorthesis in: Rheumatology, 2008, Elsevier Limited. ISBN   978-0-323-04430-1
  6. Ray, Charles E. (2008-04-21). Pain Management in Interventional Radiology. Cambridge University Press. pp. 178–. ISBN   978-0-521-86592-0 . Retrieved 19 July 2011.
  7. Rodriguez-Merchan, E. Carlos; Valentino, Leonard A. (2011-04-27). Current and Future Issues in Haemophilia Care. Wiley-Blackwell. pp. 548–. ISBN   978-1-119-97938-8 . Retrieved 19 July 2011.