Good long-term outcome of synovectomy in advanced stages of the rheumatoid elbow

Abstract

Background and purpose Synovectomy is an effective procedure for management of the rheumatoid elbow at radiographically early stages (Larsen grades 1 and 2). However, its efficacy for advanced stages (Larsen grades 3–5) is controversial. We investigated the outcome of synovectomy for advanced stages of the rheumatoid elbow.

Methods Between May 1985 and September 1994, synovectomy was performed for 67 rheumatoid elbows in 59 patients (mean age 52 (26–72) years, 54 women). 3 elbows (3 patients) were lost to follow-up after mean 15 (10–23) years. Thus, 64 elbows were evaluated clinically and radiographically.

Results The mean Mayo elbow performance score (MEPS) improved from 42 (15–75) points preoperatively to 78 (45–100) points at the final follow-up examination. In cases of Larsen grade 5, the mean MEPS at final follow-up examination (69 points) was lower than those of Larsen grade 3 and 4 cases (80 and 79 points, respectively) (p < 0.01). Recurrence of synovitis was obvious in 20/67 elbows. 12 cases had a total elbow arthroplasty mean 13 years after the synovectomy. The 10-year, 15-year, and 20-year survival rates were 97%, 75%, and 70%, respectively.

Interpretation Our findings suggest that synovectomy for the rheumatoid elbow gives a good long-term outcome for radiographically judged destroyed joints of Larsen grades 3–4.

KI: design of the study, data collection, literature search, and manuscript preparation. YI, YM, TS: design of the study, surgery, manuscript preparation, and supervision.

We thank YutakaInaba, Yuichi Mochida, and Tomoyuki Saito-all the orthopedic surgeons who participated at Yokohama City University.

No competing interests declared.