Evaluating functional recovery post-total knee replacement, a WOMAC based comparison of synovectomy versus non-synovectomy approaches in a tertiary care hospital in South India
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251128Keywords:
Functional outcomes, Inflammatory arthritis, Osteoarthritis, Synovectomy, Total knee arthroplasty, WOMACAbstract
Background: Synovectomy is commonly performed during total knee arthroplasty (TKA) for patients with osteoarthritis (OA) and inflammatory arthritis to address synovial inflammation. However, its impact on long-term functional outcomes remains unclear. Objective of this study was to evaluate the effect of synovectomy during TKA on postoperative pain, stiffness, and functional outcomes in patients with OA and inflammatory arthritis.
Methods: A hospital-based retrospective cohort study was conducted with 86 patients who underwent TKA one year prior (43 with synovectomy, 43 without). The Western Ontario and McMaster osteoarthritis index (WOMAC) was used to assess pain, stiffness, and physical function at follow-up.
Results: The mean age of patients was 65.4 years. No significant differences were found in pain (p=0.638) and stiffness (p=0.647) between the two groups. However, physical function was significantly better in the group without synovectomy (p=0.004), with significantly fewer difficulties in activities such as standing, bending, and getting in/out of bed (p<0.05). The mean total WOMAC score was significantly lower in the group without synovectomy (p=0.045).
Conclusions: Synovectomy during TKA had no impact on postoperative pain or stiffness and was associated with poorer functional outcomes compared to TKA without synovectomy. These findings suggest that synovectomy may not offer additional benefits for patients with OA and inflammatory arthritis. Further research with larger samples is recommended to better understand its role in TKA.
Metrics
References
Senthelal S, Li J, Ardeshirzadeh S, Thomas MA. Arthritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
Agaliotis M, Mackey MG, Jan S, Fransen M. Burden of reduced work productivity among people with chronic knee pain: a systematic review. Occup Environ Med. 2014;71(9):651-9. DOI: https://doi.org/10.1136/oemed-2013-101997
Reginato AM, Olsen BR. The role of structural genes in the pathogenesis of osteoarthritic disorders. Arth Res. 2002;4(6):337-45. DOI: https://doi.org/10.1186/ar595
Siva C, Velazquez C, Mody A, Brasington R. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Phys. 2003;68(1):83-90.
Wisłowska M. Etiopathogenesis of rheumatoid arthritis. Przegl Lek. 1996;53(10):755-60.
Skoczyńska M, Chowaniec M, Szymczak A, Langner-Hetmańczuk A, Maciążek-Chyra B, Wiland P. Pathophysiology of hyperuricemia and its clinical significance- a narrative review. Reumatologia. 2020;58(5):312. DOI: https://doi.org/10.5114/reum.2020.100140
Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Phys. 2021;104(6):589-97.
Justiz Vaillant AA, Goyal A, Varacallo M. Systemic lupus erythematosus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
Singh JA, Tugwell P, Zanoli G, Wells GA. Total joint replacement surgery for knee osteoarthritis and other non‐traumatic diseases: a network meta‐analysis. Cochrane Database Syst Rev. 2019;2019(9):CD011765. DOI: https://doi.org/10.1002/14651858.CD011765.pub2
Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, et al. Knee replacement. Lancet Lond Engl. 2018;392(10158):1672-82. DOI: https://doi.org/10.1016/S0140-6736(18)32344-4
Lee JK, Choi CH. Total knee arthroplasty in rheumatoid arthritis. Knee Surg Relat Res. 2012;24(1):1-6. DOI: https://doi.org/10.5792/ksrr.2012.24.1.1
Krasnokutsky S, Belitskaya-Lévy I, Bencardino J, Samuels J, Attur M, Regatte R, et al. Quantitative magnetic resonance imaging evidence of synovial proliferation is associated with radiographic severity of knee osteoarthritis. Arth Rheum. 2011;63(10):2983-91. DOI: https://doi.org/10.1002/art.30471
Momohara S, Ikeda M, Uchida K, Kawamura K, Mizumura T, Tomatsu T. Follow-up results of arthroscopic synovectomy for the rheumatoid knee. Mod Rheumatol. 2001;11(3):205-9. DOI: https://doi.org/10.3109/s101650170005
Furuzawa-Carballeda J, Macip-Rodríguez PM, Cabral AR. Osteoarthritis and rheumatoid arthritis pannus have similar qualitative metabolic characteristics and pro-inflammatory cytokine response. Clin Exp Rheumatol. 2008;26(4):554-60.
Zhaoning X, Xu Y, Shaoqi T, Baiqiang H, Kang S. The effect of synovectomy on bleeding and clinical outcomes for total knee replacement. Bone Joint J. 2013;95-B(9):1197-200. DOI: https://doi.org/10.1302/0301-620X.95B9.31253
Rankin KS, Ramaskandhan J, Bardgett M, Merrie K, Gangadharan R, Wilson I, et al. Synovectomy during total knee arthroplasty: a pilot single-centre randomised controlled trial. Pilot Feasibil Stud. 2018;4:145. DOI: https://doi.org/10.1186/s40814-018-0336-y
Kilicarslan K, Yalcin N, Cicek H, Dogramaci Y, Ugurlu M, Ozkan H, et al. The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study. Knee Surg Sports Traumatol Arthrosc. 2011;19(6):932-5. DOI: https://doi.org/10.1007/s00167-010-1270-6
Tanavalee A, Honsawek S, Rojpornpradit T, Sakdinakiattikoon M, Ngarmukos,S. Inflammation related to synovectomy during total knee replacement in patients with primary osteoarthritis: a prospective, randomised study. J Bone Joint Surg Br. 2011;93:1065-70. DOI: https://doi.org/10.1302/0301-620X.93B8.26719
Downloads
Published
How to Cite
Issue
Section
