Synovectomy: Removal of Inflamed Synovium

Introduction to Synovectomy

A synovectomy is a surgical procedure designed to remove inflamed synovial tissue from a joint. The synovium is a thin membrane that lines joints, producing fluid to lubricate movement. When this tissue becomes inflamed due to conditions like rheumatoid arthritis or synovitis, it can cause pain, swelling, and joint damage. A synovectomy helps alleviate symptoms and prevent further joint deterioration.

This procedure is commonly performed on knees, elbows, wrists, and fingers. Depending on the severity, it can be done through open surgery or minimally invasive arthroscopy. Understanding the process, recovery, and outcomes can help patients make informed decisions about their treatment.

Why is a Synovectomy Needed? (Indications)

Synovectomy is typically recommended when conservative treatments like medications, physical therapy, or steroid injections fail to control synovial inflammation. Common conditions that may require this procedure include:

• Rheumatoid Arthritis: Chronic inflammation damages the synovium, leading to pain and joint deformity.
• Pigmented Villonodular Synovitis (PVNS): A rare condition causing abnormal synovial growth.
• Septic Arthritis: Infection in the joint that causes severe synovitis.
• Osteoarthritis: In some cases, inflamed synovium worsens joint degeneration.

If left untreated, chronic synovitis can erode cartilage and bone, making early intervention crucial.

Types of Synovectomy Procedures

Depending on the joint affected and the severity of inflammation, surgeons may recommend different synovectomy techniques:

• Arthroscopic Synovectomy: A minimally invasive approach using small incisions and a camera (arthroscope) to remove inflamed tissue. Preferred for knees, shoulders, and wrists.
• Open Synovectomy: Involves a larger incision for direct access to the joint. Used for severe cases or complex joints like the hip.
• Radiation Synovectomy: A non-surgical option where radioactive material is injected to shrink the synovium (used in some rheumatoid arthritis cases).
• Chemical Synovectomy: Involves injecting substances like osmic acid to destroy abnormal synovial tissue (less common today).

Your surgeon will choose the best method based on your condition and overall health.

Preparing for Synovectomy Surgery

Proper preparation ensures a smoother procedure and recovery. Here’s what to expect:

• Medical Evaluation: Blood tests, imaging (X-ray, MRI), and a physical exam assess joint damage and overall health.
• Medication Adjustments: Some drugs (e.g., blood thinners) may need to be paused before surgery.
• Fasting: No food or drink for 8–12 hours before the procedure if general anesthesia is used.
• Pre-Surgery PT: Strengthening exercises may improve post-op recovery.
• Home Preparations: Arrange for help with daily tasks and set up a recovery space with essentials within easy reach.

Your surgical team will provide personalized instructions to follow.

Step-by-Step Procedure: How Synovectomy is Performed

While techniques vary, a typical synovectomy follows these steps:

1. Anesthesia: General or regional anesthesia ensures you feel no pain during surgery.
2. Incision: For arthroscopy, 2–3 small cuts are made; open surgery requires a larger incision.
3. Joint Access: The surgeon inserts an arthroscope (if used) to visualize the synovium.
4. Synovial Removal: Inflamed tissue is carefully cut away using specialized tools.
5. Irrigation & Closure: The joint is flushed to remove debris, and incisions are stitched closed.
6. Bandaging: Sterile dressings are applied, and a brace may be fitted for support.

The surgery usually takes 1–2 hours, depending on complexity.

Recovery & Post-Operative Care

Recovery varies by procedure type but generally follows these stages:

• Hospital Stay: Arthroscopy may be outpatient; open surgery could require 1–2 days in the hospital.
• Pain Management: Medications and ice packs help control discomfort.
• Mobility: Crutches or a sling may be needed initially. Physical therapy starts within days to restore strength and flexibility.
• Wound Care: Keep incisions clean and dry to prevent infection.
• Activity Restrictions: Avoid heavy lifting or strenuous activity for 4–6 weeks.

Full recovery can take 3–6 months, with gradual improvements in joint function.

Risks & Possible Complications

While synovectomy is generally safe, potential risks include:

• Infection: Rare but possible at incision sites or in the joint.
• Bleeding or Blood Clots: More common with open surgery.
• Nerve Damage: May cause temporary numbness or weakness.
• Stiffness: Scar tissue can limit motion without proper rehab.
• Recurrence: Inflammatory conditions like RA may cause synovitis to return over time.

Choosing an experienced surgeon minimizes these risks.

Benefits & Expected Outcomes

When successful, synovectomy offers significant improvements:

• Pain Relief: Reduced inflammation alleviates chronic discomfort.
• Improved Mobility: Restores smoother joint movement.
• Joint Preservation: Prevents further cartilage and bone damage.
• Delayed Joint Replacement: Can postpone the need for more invasive surgeries.
• Higher Quality of Life: Many patients resume daily activities with less limitation.

Success rates are high, especially when combined with ongoing disease management.

FAQs About Synovectomy