Synovectomy of the knee

The knee joints are the second largest joints in the human body after the hips. They have a complex structure and provide movement in two axes – frontal (flexion-extension) and vertical (inward and outward rotation).

To smooth out irregularities in the articular surfaces of the femur and tibia, cushioning and distributing the load on the joint, there are two movable fibrocartilaginous semicircular formations inside it – the meniscus.

The joint has its own capsule, which is covered from the inside with a thin synovial membrane (synovium), which passes to the menisci as well. The cells of the synovial membrane produce synovial fluid to lubricate the intraarticular surfaces, and also perform protective phagocytic functions.

The amount of synovial lubrication that is inside the cavity is 2-4 ml. In some pathologies, its volume may decrease or increase significantly.

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

Damage to the inner shell of the articular capsule is resistant to ongoing conservative treatment, therefore, in many cases, only surgery can stop the progression of the knee pathology and preserve its mobility.

Synovectomy of the knee joint is a surgical intervention that involves the excision (removal) of the synovial membrane. Synovectomy stops the degeneration of the synovium and restores normal joint function.

Indications and contraindications

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

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

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

Preparing for an operation

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

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

Course of operation

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

The arthroscopic procedure is considered gentle and minimally traumatic to the knee. As a result, there are fewer complications after arthroscopic surgery than after open surgery. The procedure is quite complicated to perform and requires special qualifications of the doctor.

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, 7 mm long each. Arthroscope tubes and microsurgical instruments are inserted through these incisions.

After the bursa has been punctured, the arthroscope is inserted into the cavity. Using an optical device, the cavity is examined and the area for excision of the shell is determined. Excised tissues are removed from the joint cavity.

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

Arthroscopic synovectomy can be performed as an independent procedure or as part of an intra-articular operation, such as removal of neoplasms, menisci, or joint mice (for 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 recovers 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 the operation, the patient needs to undergo physiotherapy procedures that help accelerate wound healing and restore normal functioning of the knee joint.

Simultaneously with physiotherapeutic procedures, physiotherapy exercises are shown to patients. The patient must move with the help of crutches, so as not to load the operated joint. When it is possible to refuse crutches, only the traumatologist decides, based on the rate of restoration of joint functions.

The synovial membrane after a complete synovectomy in most cases is completely restored 6 months after the operation.

Possible complications

The risk of complications after an open synovectomy is much higher than with an arthroscopic one. The consequences of open surgery include hematomas, pain syndrome, cicatricial deformities, leading to a limitation of the 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 synovium, the microcirculatory intra-articular 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.

To avoid the dangerous consequences of the intervention on the knee joint, the patient must strictly follow all the doctor’s recommendations, take the necessary medications, visit a physiotherapy room, and subsequently exercise therapy (exercise therapy).

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

Low trauma and good recovery after arthroscopic synovectomy makes this operation 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.