Arthroscopic Synovectomy: Who needs it and why?

Health experts on Arthroscopic Synovectomy, the patients that it is typically recommended for and why

Arthroscopic Synovectomy is a minimally invasive surgical procedure that involves the removal of inflamed synovial tissue from inside a joint using an arthroscope. The synovial tissue is the lining of the joint that produces synovial fluid, which lubricates and nourishes the joint.

Arthroscopic Synovectomy: Who needs it and why? (Photo by philippe spitalier on Unsplash)

In an interview with HT Lifestyle, Dr Siddhart Yadav, Consultant Orthopaedic and Joint Replacement Surgeon at Apollo Hospitals in Navi Mumbai, “Arthroscopic Synovectomy is typically recommended for patients with inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, or other forms of inflammatory arthritis. These conditions can cause the synovial tissue to become inflamed and thickened, leading to pain, stiffness, and joint damage. The goal is to remove the inflamed synovial tissue, reduce joint pain and inflammation, and slow down or prevent further joint damage.”

He added, “The procedure may be performed on any joint, but it is most commonly done on knee, shoulder, ankle, elbow and wrist. The decision to perform arthroscopic synovectomy depends on a variety of factors, including the severity of the joint inflammation, the presence of joint damage, and the patient's overall health and medical history. Arthroscopic Synovectomy is usually recommended when other non-surgical treatments, such as medications, physical therapy, and injections, have not provided adequate relief of joint pain and stiffness.”

Bringing his expertise to the same, Dr Vineet Tyagi, Associate Director, Department of Orthopaedics at Max Super Speciality Hospital in Dehradun, “Arthroscopic Synovectomy is an arthroscopic (keyhole) surgical procedure in which abnormal or inflamed synovium is removed from the joints. The synovium is a thin-layered membrane that lines the inside of synovial joints. Common synovial joints are shoulder, knee, hip, elbow, wrist etc. The function of the synovium is to provide synovial fluid or lubrication in these joints, allowing the bones in the joint to move and glide freely against each other.”

He highlighted, “In usual cases, various forms of arthritis like rheumatoid or other inflammatory arthritis, injury to the concerned joint or even excessive usage can lead to synovitis of that particular joint. This leads to swelling in the synovial layer, which then secretes more than normal synovial fluid that result in damage to the cartilage of the joint. An excess of inflamed synovial tissue can result in abnormal swelling and persistent joint pain. Joints with synovitis can have symptoms like pain, stiffness and difficulty in movements. Loss of cartilage eventually leads to permanent damage to the joint surface. With the help of arthroscopic synovectomy, we can effectively deal with problems related with synovitis. In this procedure, with the help of an arthroscope, without any big surgical incisions, the inflamed synovial tissue is removed from inside the joint. This procedure can help to prevent further arthritic damage in the joint and present recurrent joint pains and swelling. A timely done procedure helps in preventing complications associated with synovitis causing cartilage damage.”

Dr Ayyappan V Nair, Consultant - Shoulder Surgery, Sports Medicine and Arthroscopy at Manipal Hospital, Whitefield, Sarjapur and Jayanagar in Bangalore, revealed, “Synovium is the inner lining of the joint. All joints, including knee joints and hip joints - all of them has a synovial lining. Synovium produces fluid that acts as a lubricant for the joints. It helps in movement and prevents any kind of arthritic problems. When there are certain arthritic conditions or conditions that affect the synovium, such as Pigmented Villonodular Synovitis (PVNS), the synovium produces abnormal fluid as well as loose bodies or cartilaginous bodies inside. In that kind of scenario, we have to remove the synovium partially or completely. The procedure is done as keyhole surgery or arthroscopy where we will create 2 to 3 small keyholes through which we pass a camera into the joint using a catheter to do the procedure. We regularly perform hip arthroscopy and synovectomy of the knee and the other joints in our hospital. It is a quick procedure and takes only around half an hour time. Patients can stay in the hospital for one day after the procedure for observation.”