DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20183676

A study on the outcome of arthroscopic synovial biopsy and synovectomy in the management of chronic synovitis of the knee

Vineet Thomas Abraham, M. Gokul Anand, R. Krishnagopal

Abstract


Background: Synovitis of the knee can be very difficult to treat especially when the diagnosis remains elusive. Synovitis occurs because of various causes. We assess the patients presenting to our hospital with synovitis of the knee, who underwent arthroscopic synovial biopsy and partial arthroscopic synovectomy and did a review of literature.

Methods: This retrospective study included 25 patients with chronic synovitis of the knee presenting to our institution between July 2012 to January 2016. Inclusion criteria were patients presenting with persistent swelling of the knee; not responding to conservative measures. We excluded patients who had recurrent synovitis, patients who had septic arthritis. All patients underwent Arthroscopic synovial Biopsy and partial synovectomy. Preoperative and postoperative VAS score was calculated.

Results: In n=6 patients the histopathological diagnosis was Tuberculosis, which improved with Anti tuberculous drug treatment. In n=1 patient the diagnosis was lipoma arborescens, in n=1 patient the diagnosis was plant thorn synovitis, in n=3 patient the diagnosis was Juvenile rheumatoid arthritis; all 5 patients improved with synovectomy and NSAIDS. In n=14 patients the biopsy report came as chronic non-specific synovitis, 8 of these patients did well with arthroscopic synovectomy while the other 6 had a recurrence. The average VAS score improved from 8.8- pre surgery to 4.7 post surgery.

Conclusions: Arthroscopic synovial biopsy and synovectomy gives good results in patients with chronic synovitis of the knee. It may be recommended as a treatment for chronic synovitis of the knee, which is not responding to conservative measures of treatment.


Keywords


Chronic synovitis, Arthroscopy, Biopsy, Synovectomy

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References


Tak PP, Breedveld FC. Current Perspectives on Synovitis. Arthritis Res Therapy. 1999;1(1):11-6.

Youssef PP, Kraan M, Breedveld F, Bresnihan B, Cassidy N, Cunnane G, et al. Quantitative microscopic analysis of inflammation in rheumatoid arthritis synovial membrane samples selected at arthroscopy compared with samples obtained blindly by needle biopsy. Arthritis Rheum. 1998;41:663–9.

Singhal O, Kaur V, Kalhan S, Singhal MK, Gupta A, Machave YY. Arthroscopic synovial biopsy in definitive diagnosis of joint diseases: An evaluation of efficacy and precision. International Journal of Applied and Basic Med Res. 2012;2(2):102-6.

Akmese R, Yildiz KI, Isik C, Tecimel O, Bilgetekin YG, Firat A, et al. Combined arthroscopic synovectomy and radiosynoviorthesis in the treatment of chronic non-specific synovitis of the knee. Arch Orthop Trauma Surg. 2013;133(11):1567-73.

Kuzmanaova SI, Zaprianov ZN, Solakov PT. Correlations between arthroscopic findings and synovial membrane histology in patients with rheumatoid synovitis of the knee joint. Folia Med (Plovdiv). 2003;45(3):60-5.

Latosiewicz R, Cylwik B, Dołzyński M. Clinical significance of arthroscopic synovial biopsy in the diagnosis of knee synovitis.Chir Narzadow Ruchu Ortop Pol. 1998;63(6):549-53.

Duerinckx JFH. Subacute Synovitis of the Knee After a Rose Thorn Injury. Clin Orthop Relat Res. 2008;466:3138–42.

Ayral X, Bonvarlet JP, Simonnet J, Amor B, Dougados M. Arthroscopy-assisted synovectomy in the treatment of chronic synovitis of the knee. Rev Rhum Engl Ed. 1997;64(4):215-26.