Synovectomy is the surgical removal of the synovial tissue surrounding a

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

. This procedure is typically recommended to provide relief from a condition in which the

synovial membrane Synovial () may refer to: * Synovial fluid * Synovial joint A synovial joint, also known as diarthrosis, joins bones or cartilage with a fibrous joint capsule that is continuous with the periosteum of the joined bones, constitutes the outer bou ...

or the joint lining becomes inflamed and irritated and is not controlled by medication alone. If

arthritis Arthritis is a general medical term used to describe a disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, Joint effusion, swelling, and decreased range of motion of ...

(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. A ''synovectomy'' is a procedure often suggested for those with

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

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 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: * Inflammatory arthritis: rheumatoid arthritis, hemophilia, chondromatosis * Synovial tumors: pigmented villonodular synovitis *

Septic arthritis Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typica ...

Joint stiffness Joint stiffness may be either the symptom of pain on moving a joint, the symptom of loss of range of motion or the physical sign of reduced range of motion. * Pain on movement is commonly caused by osteoarthritis, often in quite minor degrees, ...

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 Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

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

edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...

tous and thicken with inflammatory exudates. Moreover, similar conditions can also be seen in juvenile rheumatoid arthritis and

psoriatic arthritis Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that may occur in some people affected by the autoimmune disease psoriasis. The classic features of psoriatic arthritis include dactylitis (sausage-like swelling of the fingers ...

. Synovectomy for RA has become relatively rare because nowadays patients with Rheumatoid Arthritis 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.

Variants

Synoviorthesis, or medical synovectomy, may be achieved with the intra-articular injection of several substances:Hochberg Marc C., Silman Alan J. ''CHAPTER 40: Aspiration and injection of joints.../Synoviorthesis'' in: ''Rheumatology'', 2008, Elsevier Limited. * Osmic acid, rifampicin and

rifamycin The rifamycins are a group of antibiotics that are synthesized either naturally by the bacterium '' Amycolatopsis rifamycinica'' or artificially. They are a subclass of the larger family of ansamycins. Rifamycins are particularly effective aga ...

(i.e. chemosynovectomy) *

Yttrium-90 Yttrium-90 () is a radioactive isotope of yttrium. Yttrium-90 has found a wide range of uses in radiation therapy to treat some forms of cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the ...

, erbium-169,

dysprosium-165 Naturally occurring dysprosium (66Dy) is composed of 7 stable isotopes, 156Dy, 158Dy, 160Dy, 161Dy, 162Dy, 163Dy and 164Dy, with 164Dy being the most abundant (28.18% natural abundance). Twenty-nine radioisotopes have been characterized, with the ...

and rhenium-186 (radiosynovectomy)

References

{{Bone, cartilage, and joint procedures Surgical removal procedures Orthopedic surgical procedures

Indications

Pigmented villonodular synovitis (PVNS)

Rheumatoid arthritis (RA)

Variants

See also

References