An arthroscopic or invasive synovectomy entails the surgical removal of diseased synovial disease covering of the joint. Debulking the pathologic tissues will lessen discomfort and decrease cartilage loss in cases like rheumatoid arthritis when the disease involves a continuously inflamed synovium. Synovectomy can help alleviate pain in real life as long as cartilage is there.
Alternate Name of Synovectomy Surgery
Joint synovectomy
Synovectomy Procedure Type
The synovectomy procedure has two processes, either openly or arthroscopically. Your doctor will explain the type of procedure to be undertaken.
Where is a Synovectomy Surgery Performed?
Ankle, knee, shoulder, wrist, hip & elbow synovial joints can undergo synovectomies.
Preparation for a Synovectomy Surgery
A thorough patient assessment is necessary before deciding whether to undertake surgery.
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Health assessment: A complete history is taken, and the afflicted joint is physically examined to determine the extent of the injury. Moreover, it also determines the level of suffering and discomfort and the joint's flexibility.
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Imaging investigations: The affected joints need to be radiographically classified using the following procedures to understand the pathophysiology better and verify the diagnosis.
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X-ray: This straightforward radiological exam is widely accessible. As a result, it offers pictures of the diseased joints.
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MRI: The exam occurs inside a small tube emitting loud noises. Before the exam, request earplugs to reduce exposure to sound. An MRI offers detailed pictures of the joints.
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Ultrasonography: An ultrasonography examination involves moving a small probe across the skin while pressing it against the surface. Viewing the body's connective tissue is beneficial.
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Scintigraphy: In such a test, a radiotracer is administered orally, intravenously, or inhaled. As a result, the radiotracer reaches the targeted aberrant spots. And a specialized camera and machine are used to take the pictures.
Test Before Synovectomy Surgery
Days before any elective operation, routine testing is important. The tests are as follows:
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Platelet count analysis to examine blood and haemoglobin levels.
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Time for bleeding and clotting
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Viral screening
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Blood type and blood grouping
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Urine test
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Test of renal function
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Test for liver function
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A chest X-ray
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Electrocardiogram
How is Synovectomy Surgery Performed?
The two most common synovectomy types are:
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Open synovectomy
It involves a skin incision close to the joint and gently dissecting the soft tissues. identification and removal of the aberrant synovial porous membrane will occur. Your surgeon will remove debris and loose bodies free in the synovial joint.
Additionally, the doctor will remove any adhesions or fibrous tissue. Both the skin and soft tissue would need stitches back together.
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Arthroscopic synovectomy
This technique requires three to four tiny incisions on the skin close to the joint. The surgeon puts an arthroscope, a small tube with a lens on one end, into an incision. The ability to see the joints on a screen is helpful. Small surgical tools that assist in cutting and eliminating the extra synovium are inserted via the remaining wounds. By using electrocautery, the doctor can control bleeding. After the synovectomy is over, the skin incisions need stitches. Over the incision, a compressive covering is provided.
A significant number of synovectomies are performed arthroscopically. Recurring synovectomies are sometimes are needed to prevent progress of the disease.
Follow Up After Synovectomy Surgery
Before your discharge from the hospital, your physician or a staff member will inform you about the required follow-up appointments. The first appointment may take place within a week or ten days to remove the sutures and assess the joint's healing. A synovectomy can significantly enhance functioning and relieve discomfort. Most patients with intact articular cartilage often have outstanding results.
Your knee would be immobilized in a removable cast after a knee synovectomy. The intra-articular vacuum drain is typically removed 24 hours following surgery, and physiotherapy often begins one to two days later. Infections are possible with every surgical operation.
Although postoperative stiffening is frequent and more inclined to occur after surgical intervention than with arthroscopy, the procedure has minimal complication rates. Physical therapy is necessary to address stiffness.
Risks & Complications of Synovectomy Surgery
Complications are possible with every surgical operation. Some of the following risks are mentioned below.
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A knee wound caused by bleeding.
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Injury to the knee's tendons, ligament, or cartilage.
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Blood clot in the leg.
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Damage to a nerve or blood artery.
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Joint inflammation in the knee.
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Stiffness in the knees after the operation.
Recovery After Synovectomy Surgery
The method varies depending on the concerned joint and the extent of the incisions needed for the treatment. Also, recovery range-of-motion workouts are crucial for bigger joints, like the knee, after a synovectomy. Patients are placed on constant passive movement (CPM) devices as soon as possible following surgery.
In most cases, however, physical treatment will start after one or two sessions. To restore joint mobility, working with the proper rehabilitation therapist is crucial. Following surgery, the person must keep taking medicine to prevent further joint damage and postpone synovial swelling in the treated joint.
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