Synovectomy is a surgical procedure to remove excessive joint lining (synovium).
Page updated March 2024 by Dr Sheila Strover (Clinical Editor)
Indications for synovectomy
Synovectomy may be indicated when florid overgrowth of synovium tissue occurs, either as a response to some inflammatory trigger like rheumatoid arthritis or when there is abnormal overgrowth of synovial tissue such as in synovial chondromatosis.
Special cases included pigmented villonodular synovitis and haemophilia.
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Quote from peer-reviewed paper:
"....arthroscopic synovectomy and removal of loose bodies.... [is indicated in] in synovial osteochondromatosis of the knee...."
Citation: Leung OT, Lui TH. Arthroscopic Synovectomy and Removal of Loose Bodies in Synovial Osteochondromatosis of the Knee. Arthrosc Tech. 2023 Jun 5;12(7):e1057-e1063. doi: 10.1016/j.eats.2023.02.023. PMID: 37533918; PMCID: PMC10390706.
How is synovectomy performed?
Surgical synovectomy may be performed either as an open procedure or arthroscopically (keyhole procedure).
An open procedure is chosen if there is a very large amount of tissue to remove and ordinary instruments are used. If arthroscopy is indicated the tissue is usually ablated using a rotating burr or a less damaging radiofrequency wand, which appears to simply melt the tissue.
Chemical and radioactive synovectomy are also options.
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Quote from peer-reviewed paper:
"....When [arthroscopic synovectomy] is performed alone, it is impossible to access the entire knee and remove all of the inflamed tissue...."
Citation: Karaman I, Guney A, Dogar F, Kafadar IH, Bilal O, Oner M, Kula M. Comparison of arthroscopic, radioactive and combined synovectomy in the treatment of chronic non-specific knee synovitis. Med Princ Pract. 2014;23(6):551-5. doi: 10.1159/000365635. Epub 2014 Aug 29. PMID: 25196268; PMCID: PMC5586937.
Complications of synovectomy
The two main complications are bleeding (haemarthrosis) or thermal damage to the synovium.
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Quote from peer-reviewed paper:
"....In cases of chronic non-specific synovitis, surgery involving [radioactive synovectomy] should be performed in those who have derived no benefit from conservative therapy....[but] complications such as radionecrosis develop in some patients...."
Citation: Karaman I, Guney A, Dogar F, Kafadar IH, Bilal O, Oner M, Kula M. Comparison of arthroscopic, radioactive and combined synovectomy in the treatment of chronic non-specific knee synovitis. Med Princ Pract. 2014;23(6):551-5. doi: 10.1159/000365635. Epub 2014 Aug 29. PMID: 25196268; PMCID: PMC5586937.