Synovectomy (Arthroscopic or Open): A Complete Guide

Introduction to Synovectomy

If you or a loved one is suffering from chronic joint pain, swelling, or inflammation due to conditions like rheumatoid arthritis or synovitis, your doctor may recommend a synovectomy. This surgical procedure involves removing the inflamed synovial tissue lining the joint to relieve pain and improve mobility.

Synovectomy can be performed either as an arthroscopic (minimally invasive) or open surgery, depending on the severity of the condition. While the idea of surgery might seem daunting, understanding the procedure, recovery process, and expected outcomes can help ease concerns.

In this guide, we’ll break down everything you need to know about synovectomy—from what it is and who needs it, to the recovery process and potential risks. By the end, you’ll have a clear picture of what to expect and how this surgery could help restore your joint function.

What is Synovectomy? (Definition & Purpose)

A synovectomy is a surgical procedure where the inflamed synovium (the soft tissue lining the joints, tendons, or bursae) is removed. The synovium produces fluid that lubricates joints, but when it becomes inflamed (as in rheumatoid arthritis or synovitis), it can cause pain, swelling, and joint damage.

The primary goals of a synovectomy are:

• Reduce pain and swelling in the affected joint.
• Slow or prevent further joint damage caused by chronic inflammation.
• Improve mobility and function of the joint.

This procedure is commonly performed on joints like the knee, elbow, wrist, hip, or shoulder. While synovectomy doesn’t cure the underlying disease (like rheumatoid arthritis), it can significantly improve quality of life by reducing symptoms and preserving joint function.

Types of Synovectomy (Arthroscopic vs. Open)

There are two main approaches to synovectomy:

1. Arthroscopic Synovectomy (Minimally Invasive)

This is the preferred method when possible. The surgeon makes small incisions and inserts an arthroscope (a tiny camera) and specialized tools to remove the inflamed synovium. Benefits include:

• Smaller incisions → less scarring.
• Faster recovery time.
• Lower risk of complications.

2. Open Synovectomy

Used for more severe cases or hard-to-reach joints, this involves a larger incision to directly access and remove the synovium. Open synovectomy may be needed if:

• The joint damage is extensive.
• Previous arthroscopic surgery was unsuccessful.
• The joint anatomy makes arthroscopy difficult (e.g., hip or ankle).

Your surgeon will recommend the best approach based on your condition, joint affected, and overall health.

Conditions That May Require Synovectomy

Synovectomy is typically recommended for patients with chronic joint inflammation that hasn’t responded to medications or other treatments. Common conditions include:

• Rheumatoid Arthritis (RA): An autoimmune disease causing synovial inflammation.
• Pigmented Villonodular Synovitis (PVNS): A rare, benign tumor-like growth in the synovium.
• Septic Arthritis: Joint infection leading to severe synovitis.
• Osteoarthritis with Synovitis: When inflammation worsens joint degeneration.
• Juvenile Idiopathic Arthritis (JIA): Persistent synovitis in children.

If you experience persistent joint pain, swelling, stiffness, or reduced mobility despite medication or physical therapy, your doctor may suggest a synovectomy to prevent further damage.

Preparing for Synovectomy Surgery

Proper preparation can help ensure a smooth surgery and recovery. Here’s what to expect:

Before Surgery:

• Medical Evaluation: Blood tests, imaging (X-ray/MRI), and a review of medications.
• Lifestyle Adjustments: Stop smoking, avoid blood thinners (aspirin, ibuprofen).
• Pre-Surgery PT: Strengthening exercises may improve recovery.

Day of Surgery:

• Fasting: No food or drink for 8–12 hours before.
• Arrival: Plan to arrive early for pre-op checks.
• Anesthesia: Most synovectomies use general or regional anesthesia.

Ask your surgeon about post-surgery assistive devices (crutches, slings) you might need.

The Synovectomy Procedure: Step-by-Step

Here’s what happens during a typical synovectomy:

1. Anesthesia: You’ll be given general or regional anesthesia to ensure no pain.
2. Incision: For arthroscopic surgery, 2–3 small cuts are made; open surgery requires a larger incision.
3. Synovium Removal: The surgeon carefully removes inflamed tissue while preserving healthy structures.
4. Closure: The incisions are closed with stitches or staples.

The surgery usually takes 1–2 hours, depending on the joint and technique. You’ll be monitored in recovery before being discharged (if outpatient) or admitted for observation (if open surgery).

Recovery & Rehabilitation After Synovectomy

Recovery varies based on the type of surgery:

Initial Recovery (First 2 Weeks):

• Pain Management: Prescribed medications and ice packs help with discomfort.
• Rest & Elevation: Keep the joint elevated to reduce swelling.
• Limited Movement: A brace or splint may be needed initially.

Rehabilitation (Weeks 2–6+):

• Physical Therapy: Gradual exercises to restore strength and flexibility.
• Activity Progression: Slowly return to daily activities; avoid high-impact movements.

Full recovery can take 6 weeks to 3 months. Arthroscopic patients typically recover faster than open-surgery patients.

Risks & Complications of Synovectomy

While generally safe, synovectomy carries some risks:

• Infection: Rare but possible; antibiotics are given preventively.
• Bleeding or Blood Clots: More common in open surgery.
• Nerve Damage: Temporary numbness or tingling near the incision.
• Stiffness or Reduced Mobility: Physical therapy helps prevent this.
• Recurrence: Inflammatory conditions like RA may cause synovitis to return.

Choosing an experienced surgeon and following post-op instructions minimizes these risks.

FAQs About Synovectomy