After researching on Google and on an academic database of medical
journals, I have found a few things.
(1) Type of synovectomy is important. Was it open, arthroscopic, or radiative?
(2) Regrowth is a concern mainly for arthroscopic forms of the
procedure, as the nature of this procedure lends itself to incomplete
synovectomy and to repeated procedures.
(3) Radiation treatment seems to be most affective and several studies
listed below conclude that regrowth of diseased synovial tissue is
rare.
(4) In arthoscopic cases, regrowth, if it occurs, can occur after 18
months, as a study below has shown.
(5) From the WebMD website, "Risks of synovectomy include the risks of
surgery and using anesthesia and a slight risk of infection and
bleeding within the joint. There may also be a loss in the range of
motion of the joint, or the inflammation in the joint may return."
(6) http://www.hemophiliagalaxy.com/patients/managing/joint/synov.html
Many of the studies below were concerned with synovitis in the
joint tissue of the knee. I am not sure how or if results would be
different for the ankle. Any more specifics about he nature of the
synovitis and the operation would be helpful. Please be aware that I
am not a medical doctor. Best of luck.
-EM
(Note: publishing information comes before each article and is only
partially complete)
Arthroscopy: the journal of arthroscopic & related surgery: official
publication of the Arthroscopy Association of North America and the
International Arthroscopy Association [Arthroscopy] 2004 May; 20 (5),
pp. 524-7.
A case of primary synovial chondromatosis of the shoulder in a
15-year-old girl is presented. Plain radiographs revealed findings
characteristic of synovial chondromatosis. The patient was treated by
arthroscopic loose body removal and arthroscopic partial synovectomy
of the glenohumeral joint. Although immediate postoperative
radiographs showed no calcification in the joint, repeated radiographs
at 18 months after surgery revealed recurrence of calcification in the
subacromial space. Arthroscopic removal of all loose bodies and
partial synovectomy appears to be a good method of giving symptomatic
relief and early return to work. However, late recurrence should be
anticipated.
Journal of arthroplasty [J Arthroplasty] 2004 Feb; 19 (2), pp. 157-61.
This study reports the results for 10 patients with recurrent
hemarthrosis after knee joint arthroplasty. The average interval
between arthroplasty and the first instance of hemarthrosis was at 26
months, and the average number of hemarthroses per patient was 3.8. In
3 patients, the bleeding responded to simple conservative measures.
The remaining 7 needed surgery; there were 6 arthroscopic
synovectomies and 1 polyethylene revision. Impingement of the
proliferative synovium was observed in only 2 patients during surgical
intervention. In the 2 patients in whom arthroscopic management was
successful, another procedure with an electric coagulator, in addition
to a formal synovectomy, was performed. The use of a coagulator may be
helpful for direct coagulation when arthroscopic management is
selected, although open synovectomy is curative in most cases.
Country of Publication: United States NLM ID: 8109053 ISSN:
0271-6798 Subsets: IM
Degenerative changes resembling hemophilic arthropathy may be
a complication of synovial hemangioma in the knee. It is thought that
arthropathy is caused by repeated bleeding episodes similar to the
joint disease in hemophilia. Four children aged 4 to 9 years at
surgery were treated by anterior open synovectomy for intra-articular
synovial hemangiomas. At open surgery the cartilage of all patients
showed changes on the surface with yellow hematin staining in all
cases, without ulceration in three patients but one, who showed severe
degenerative changes at age 9 years. At 15 months follow-up the
patient with severe degenerative changes had severely impaired flexion
and mild extension deficit. The three others were asymptomatic at 1 to
6 years follow-up. The magnetic resonance images were typical and can
be considered pathognomonic; however, the referral diagnosis included
the correct diagnosis in none of them. Treatment should be initiated
as early as possible to reduce the risk of damage to the cartilage.
Treatment by complete open synovectomy in these four patients was
performed without significant bleeding problems, and no recurrence was
seen.
Country of Publication: Canada NLM ID: 7501984 ISSN: 0315-162X Subsets: IM
OBJECTIVE: In a retrospective study we evaluated the effect,
duration of effect, and safety of radiosynoviorthesis of the ankle in
patients with persistent synovitis, refractory to disease modifying
antirheumatic drugs (DMARD) and intraarticular glucocorticoid
injections. We estimated leakage and dose to target and non-target
organs. METHODS: Radiation synovectomy was performed by injection of
75 MBq 186rhenium colloid and 20 mg triamcinolone-hexacetonide mixed
in a volume of about 1.5 ml. About 24 hours after injection, leakage
of the radionuclide was measured with a single-head gamma camera, with
views of the ankle joint, regional (inguinal) lymph nodes, and liver.
Leakage was expressed as counts in the target region of interest
corrected for background relative to total counts corresponding with
percentage of injected dose. The effect of radiosynoviorthesis was
scored into 3 categories: (1) No effect, i.e., persistent synovitis or
only minimal reduction of swelling and/or pain, or the need of
intraarticular glucocorticoid injection within 3 months or arthrodesis
of the treated joint within 6 months. (2) Moderate effect, i.e.,
significant reduction of swelling, pain, and improvement of function.
(3) Good effect, i.e., complete or almost complete remission of
synovitis. RESULTS: The mean age of patients (28 women, 12 men) at the
time of treatment was 58 years (range 33-76); 54 consecutive
procedures in ankles of the 40 patients were evaluated. No effect was
found in 12 of 54 (22%) treated joints; moderate effect in 12 (22%),
with a mean duration of effect of 34 months (range 12-49); and good
effect in 30 (56%), with a mean duration of effect of 41 months (range
21-75). Mean effect-duration did not differ significantly between the
moderate and good effect groups. Mean leakage did not differ
significantly between the effect groups. CONCLUSION: Radiation
synovectomy of the ankle is a safe and effective treatment in
persistent synovitis, although all patients eventually experienced
recurrence of arthritis.
Country of Publication: BELGIUM NLM ID: 8211469 ISSN: 0770-3198 Subsets: IM
The clinical and radiological results of synovectomy for
rheumatoid arthritis in the ankle joint were investigated in 20 ankles
of 15 patients. The average follow-up period after synovectomy was 15
years, ranging from 10 to 25 years. The clinical evaluation at the
time of follow-up, found that only two ankles showed recurrence of
synovitis, and no patient complained of severe ankle pain disturbing
the activities of daily life. During the period between the
synovectomy and our investigation, no patients required further
surgical procedures for their ankle joints. The radiological
evaluation found that in approximately two-thirds of the cases,
deterioration of the radiological grade, evaluated with Larsen's
criteria, had continued after synovectomy. There was no considerable
radiological deterioration in the less-erosive subset patients,
classified according to Ochi's criteria (1). In the unilateral
synovectomized cases, using the non-operated ankles as the
natural-course control, osteoarthritic changes were predominant in the
operated ankle joint, and the non-operated ankle demonstrated
inflammatory disease changes. These results indicate that: (1)
synovectomy for a rheumatoid ankle is still a preferred treatment,
lessening the clinical symptom of persistent, marked synovial
proliferation resistant to medical treatment. (2) Radiological
deterioration continues after synovectomy in many cases. However, a
radiogram demonstrates predominant osteoarthritic destruction, which
indicates the natural course of rheumatoid destruction in the operated
site could be altered by synovectomy. |
