Background

Open synovectomy removes the synovial membrane from a joint. While synovectomy removes synovium lining from joints through surgery.

It reduces inflammation, alleviates pain, and improves joint function in diseased synovium.

The concept of synovectomy dates to the early 20th century when it was used to treat tuberculosis-related arthritis.

Synovectomy emerged as a treatment for rheumatoid arthritis before disease-modifying antirheumatic drugs in the span of 1940s to 1950s.

Open synovectomy is refined but often replaced by arthroscopic or radiosynovectomy techniques

It is used to treat pigmented villonodular synovitis, hemophilic arthropathy, and rheumatoid arthritis.

Joints affected by inflammatory arthritis experience pain and swelling due to inflammation and excessive synovium growth in orthopedic injuries.

In inflammatory arthritis, the immune system erroneously identifies cartilage as foreign, leading to excessive synovial growth and attack.

Indications

Rheumatoid Arthritis

Pigmented Villonodular Synovitis

Hemophilic Arthropathy

Infectious or Tuberculous Arthritis

Osteoarthritis with Synovial Overgrowth

Inflammatory Joint Diseases

Synovial Proliferative Disorders

Contraindications

Severe Joint Destruction

Active Joint Infection

Poor Skin or Soft Tissue Integrity

Uncontrolled Bleeding Disorders

Advanced Age with Poor Functional Reserve

Extensive Fibrosis and Stiffness in the Joint

Outcomes

Open synovectomy success depends on condition, disease extent, and rehabilitation.

Early detection improves outcomes before damage. It reduces frequency of joint bleeds and slows disease progression.

It also delays the need for joint replacement in younger patients.

Some patients need partial synovectomy for minimal tissue removal, while others require complete synovectomy to alleviate pain.

Synovectomy improves function and pain relief, especially in patients with intact cartilage.

Equipment required

General Orthopedic Instrument Set

Joint Exposure Instruments

Synovial Resection Tools

Suturing & Wound Closure Tools

Patient Preparation:

Evaluate the severity of joint disease, pain, range of motion, and functional limitations.

Regional anesthesia enhances early mobility in lower limb surgery.

General anesthesia required for extensive upper limb procedures.

Informed Consent:

Explain the procedure’s risks and potential complications clearly to the patient.

Patient Positioning:

For knee: In supine position with a tourniquet applied to the thigh.

For elbow: Lateral decubitus or supine with the arm on an arm board.

For Wrist/Ankle: In supine position with a tourniquet applied proximally.

Figure 1. Knee synovium

Figure 2. Wrist synovium

Technique

Step 1: Incision Selection

Select surgical approach and joint exposure to knee, elbow, wrist, and ankle as per specific guidelines.

Step 2: Synovial Resection

Synovium excision is done using scalpels, electrocautery, or arthroscopic shavers for precision.

Avoid any damage to cartilage, ligaments, or tendons.

Complete Synovectomy

It is performed in rheumatoid arthritis, pigmented villonodular synovitis (PVNS), and hemophilic arthropathy when total synovial removal is required.

Partial Synovectomy

It is considered in cases where only focal synovial hypertrophy is present

Step 3: Wound Closure

Joint capsules and fascia are closed with absorbable sutures to maintain joint stability.

Subcutaneous and skin layers closed separately with sutures.

Complications:

Excessive Bleeding

Neurovascular Injury

Cartilage or Ligament Injury

Postoperative Joint Bleeding

Joint Stiffness/Loss of Motion:

Chronic Pain/Residual Inflammation

References

Open synovectomy treatment for intra- and extraarticular localized pigmented villonodular synovitis of the knee: a case report – PMC

References

Open synovectomy treatment for intra- and extraarticular localized pigmented villonodular synovitis of the knee: a case report – PMC