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Treatment of Chronic Knee Synovitis with Arthroscopic Synovectomy: Longterm Results
FRANÇOISE ROCH-BRAS, JEAN-PIERRE DAURÈS, MARIE-CHRISTINE LEGOUFFE, JACQUES SANY, and BERNARD COMBE
ABSTRACT.
Methods. Forty-one knees of 38 patients (30 women, 8 men), mean age of 42.7 ± 15.3 years, were evaluated clinically and radiographically at a mean 8.9 years (range 5.0-12.3) after arthroscopic synovectomy. Arthroscopic synovectomies were always performed with a shaver by the same physician after failure of at least one radioactive or chemical synovectomy. Radiographs were blindly read by 2 examiners. Results. At the final evaluation, the clinical results (pain, range of motion, recurrent effusion) were good in 29 cases (70.7%) and poor in 12 cases (knee arthroplasty was required in 11 cases). Radiographs highlighted significant progression of joint damage (more than one Larsen score grade) in 16 knees (39.0%). No radiographically detectable change was observed in 12 cases (29.3%), and 11 knees (26.8%) had a change of only one Larsen score grade. There was a close correlation between the Larsen score at final examination and both Larsen score and arthroscopic score for cartilage damage at baseline. Only 4 knees (22%) with grade 0 or 1 on preoperative radiographs had significant progression of joint damage, compared to 12 knees (57%) with Larsen scores of 2 or 3 at baseline. Conclusion. These data suggest that arthroscopic synovectomy is a useful alternative treatment for chronic knee synovitis in RA after failure of radiation or chemosynovectomy, and that less severely damaged joints deteriorate less rapidly after synovectomy. (J Rheumatol 2002;29:1171-5) Key Indexing Terms:
KNEE JOINT
From the Fédération de Rhumatologie, CHU Lapeyronie, Montpellier, France. F. Roch-Bras, MD; M.C. Legouffe, MD; J. Sany, MD; B. Combe, MD, PhD, Fédération de Rhumatologie, CHU de Montpellier; J-P. Daurès, MD, PhD, Institut Universitaire de Recherche Clinique, Montpellier, France. Address reprint requests to Prof. B. Combe, Fédération de Rhumatologie, Hôpital Lapeyronie, 34295 Montpellier Cedex 5, France. Submitted March 23, 2001; revision accepted December 4, 2001. |