Medical services

Synovectomy of the knee

Knee joints are the second largest large joints in the human body after the hips. They have a complex structure and provide movement in two axes - frontal (flexion-extension) and vertical (rotation in and out).

For smoothing irregularities of the articular surfaces of the femur and tibia, depreciation and load distribution on the joint inside it there are two movable fibro-cartilaginous semicircular formations - the meniscus.

The joint has its own capsule, which is internally coated with a thin synovial membrane (synovium), which also changes to menisci. The cells of the synovial membrane produce synovial fluid to lubricate the intraarticular surfaces, and also perform protective phagocytic functions.

The amount of synovial lubricant that is inside the cavity is 2-4 ml. With some pathologies, its volume can decrease or significantly increase.

Diseases in which the synovial membrane is involved in the pathological process cause edema, pain and impaired mobility in the knee joint. Immunocompetent cells (lymphocytes, plasma cells), which produce antibodies, including autoantibodies, and inflammatory mediators, settle on the inflamed synovia.

Lesions of the inner shell of the articular capsule are resistant to conservative treatment, therefore, in many cases, only surgery can allow the progression of the knee pathology to remain and maintain its mobility.

A synovectomy of the knee joint is a surgical procedure involving excision (removal) of the synovial membrane. A synovectomy stops the degeneration of the synovial membrane and restores normal joint function.

Indications and contraindications

A synovectomy is prescribed in cases where pathological changes cannot be corrected conservatively. The purpose of this surgical intervention is to eliminate synovia as a substrate for the development of inflammation and production of exudate.

Indications for its implementation are damage to the knee joint with rheumatoid arthritis, tuberculosis, benign formations in the joint, recurrent infectious synovitis, resistant to therapeutic treatment, diffuse collagenosis, leading to impaired mobility in the joint.

The intervention is contraindicated in patients with purulent lesions of the skin and subcutaneous fat in the surgical site, with articular ankylosis (immobility), and severe somatic diseases.

Preparation for surgery

Before the operation, the patient is examined. Mandatory laboratory tests are a general blood test, a coagulogram. It is also necessary to conduct an electrocardiogram, fluoroscopic examination, including with contrast.

12 hours before the procedure, the patient should not eat and drink liquid. After the operation, the patient will need mobilizing devices and crutches, so it is advisable to purchase them in advance.

Operation progress

A synovectomy of the knee joint can be open (when opening the joint capsule) and arthroscopic. During the operation, a partial (partial) or complete excision of the synovial membrane is performed.

Arthroscopic procedure is considered gentle and minimally injures the knee. As a result of this, fewer complications arise after arthroscopic surgery than after open surgery. The procedure is quite complicated in execution and requires special medical skills.

The operation is performed under general or epidural anesthesia. Arthroscopic synovectomy is performed using a special optical device - an arthroscope, which is additionally equipped with microsurgical instruments. A tourniquet is applied to the patient's thigh to reduce blood flow to the operated limb.

The area of ​​the knee joint is treated with antiseptics, after which 3-4 incisions are made on the skin with a length of 7 mm each. Arthroscope tubes and microsurgical instruments are inserted through these incisions.

After a puncture of the joint bag, an arthroscope is inserted into the cavity. Using an optical device, inspect the cavity and determine the area for excision of the shell. Excised tissue is removed from the joint cavity.

After surgery, drainage tubes must be installed in the joint to discharge exudate, which is formed during tissue healing.

Arthroscopic synovectomy can be performed as an independent procedure or be one of the stages of intraarticular surgery, for example, removal of neoplasms, menisci or articular mice (with Koenig's disease). The operation lasts no more than an hour.

Recovery period

After the operation, the patient is placed in the ward, where he is under medical supervision until he moves away from anesthesia. The rehabilitation period after arthroscopic synovectomy usually passes quickly - within a few days. With severe pain, the patient is shown painkillers from the group of non-steroidal anti-inflammatory drugs.

Starting from the second day after surgery, the patient needs to undergo physiotherapeutic procedures that help accelerate wound healing and restore normal functioning of the knee joint.

Along with physiotherapeutic procedures, patients are shown physiotherapy exercises. The patient should move with the help of crutches, so as not to burden the operated joint. When crutches can be abandoned, only a traumatologist decides on the basis of the rate of restoration of joint functions.

The synovial membrane after complete synovectomy in most cases is fully restored after 6 months after surgery.

Possible complications

The risk of complications after open synovectomy is significantly higher than with arthroscopic. The consequences of open surgery include hematomas, pain, cicatricial deformities, leading to a limited range of motion.

The appearance of complications lengthens the rehabilitation period, and in some cases requires repeated surgical intervention.

Complete synovectomy is fraught with the development of complications. Together with the synovial membrane, the microcirculatory intraarticular network is removed, which provides the tissues of the joint, cartilage and ligaments with nutrients and oxygen. Violation of the normal blood supply to the joint leads to degenerative changes in it, which can subsequently be transformed into arthrosis.

In order to avoid the dangerous consequences of an intervention on the knee joint, the patient must strictly follow all the doctor’s recommendations, take the necessary medications, visit the physiotherapy room, and then do physical therapy (exercise therapy).

The complex of exercise therapy is the basis for the correct restoration of knee mobility.

The low morbidity and good recovery after arthroscopic synovectomy allows this operation to be considered preferable for persistent recurrent inflammatory and degenerative diseases of the knee joints.

The cost of the procedure in Russia ranges from 20 to 35 thousand rubles, which depends on the departmental affiliation of the clinic and the region.

Watch the video: ARTHROSCOPIC SYNOVECTOMY IN RHEUMATOID KNEE - Dr. Prateek Joshi (January 2020).