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The Journal of Bone and Joint Surgery (American) 84:342-347 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Arthroscopic Synovectomy of the Elbow in Rheumatoid Arthritis

Kiwamu Horiuchi, MD, Shigeki Momohara, MD, Taisuke Tomatsu, MD, Kazuhiko Inoue, MD and Yoshiaki Toyama, MD

Investigation performed at the Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan

Kiwamu Horiuchi, MD
Shigeki Momohara, MD
Taisuke Tomatsu, MD
Institute of Rheumatology, Tokyo Women’s Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo 162-0054, Japan. E-mail address for K. Horiuchi: k-hori{at}muf.biglobe.ne.jp

Kazuhiko Inoue, MD
Department of Orthopaedics, Tokyo Women’s Medical University Daini Hospital, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan

Yoshiaki Toyama, MD
Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

This paper was read in part at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Francisco, California, March 1, 2001.

Background: The purpose of this study was to investigate the results of arthroscopic synovectomy for the treatment of elbows affected by rheumatoid arthritis.

Methods: Arthroscopic synovectomy was performed on twenty-nine elbows (twenty-seven patients) between 1984 and 1996. Twenty-one elbows (twenty patients), followed for a minimum of forty-two months, were evaluated clinically with use of the Mayo elbow performance score and radiographic findings. The mean duration of follow-up was ninety-seven months. With use of the system of Larsen et al., we classified all elbows into three groupsæGrades 1 and 2, Grade 3, and Grade 4æaccording to the preoperative radiographic findings. These groups were then compared.

Results: The mean Mayo elbow performance score improved from 48.3 points preoperatively to 77.5 points (an excellent result in two elbows, a good result in thirteen, a fair result in six, and a poor result in none) at two years after the operation and 69.8 points (an excellent result in two elbows, a good result in seven, a fair result in seven, and a poor result in five) at the final follow-up evaluation. The mean score for pain improved from 9.3 points preoperatively to 31.4 points at two years after the operation and 27.9 points at the final follow-up evaluation. Clinically apparent synovitis recurred in five of the twenty-one elbows, and two of the five required total elbow arthroplasty. Among the three groups, only elbows with Larsen Grade-1 or 2 arthritis had a favorable long-term result with regard to total function. The postoperative results were unsatisfactory for Larsen Grade-4 elbows.

Conclusions: Arthroscopic synovectomy in an elbow affected by rheumatoid arthritis is a reliable procedure that can alleviate pain. Our results suggest that one of the most favorable indications for arthroscopic synovectomy is a preoperative radiographic rating of Grade 1 or 2.


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