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.