Arthroscopic Synovectomy of the Ankle in Rheumatoid Arthritis

• Published in: Arthroscopy Vol. 29; no. 1; pp. 133 - 140
• Main Authors: Choi, Woo Jin, M.D, Choi, Gi Won, M.D, Lee, Jin Woo, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013
• Subjects: Adult; Aged; Aged, 80 and over; Ankle Joint - diagnostic imaging; Ankle Joint - surgery; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - surgery; Arthroscopy - methods; Arthroscopy - statistics & numerical data; Blood Sedimentation; C-Reactive Protein - analysis; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Orthopedics; Pain Measurement; Prognosis; Radiography; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Severity of Illness Index; Synovectomy; Treatment Outcome
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2012.06.018

Purpose To evaluate the outcome of arthroscopic synovectomy of the ankle joint in patients with early-stage rheumatoid arthritis (RA). Methods Between 2005 and 2009, 18 consecutive patients with RA involving the ankle underwent arthroscopic synovectomy. Pain was measured using a visual analog scale (VAS), and clinical outcome was determined by calculating the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score with a mean follow-up of 5 years (60 months). Assessments were performed preoperatively, at 6 and 12 months postoperatively, and then yearly thereafter. Clinical success was defined as the absence of synovitis symptoms or when patients demonstrated good or excellent outcomes (AOFAS Ankle-Hindfoot Scale score ≥80) with >50% improvement in VAS score for pain. Demographic, laboratory, and radiological variables were evaluated to determine possible factors predicting clinical outcome. Results VAS and AOFAS scores were significantly improved at the final follow-up (60 months; P < .0001). The greatest improvements in clinical scores were observed after 12 months; thereafter, they steadily declined. Of the 18 patients examined, 14 (77.8%) were considered to have had clinical success with no reintervention. Variables predictive of clinical success were short duration of symptoms ( P  = .042) and minimal radiographic changes based on the Larsen grading system ( P  = .030). Conclusions Arthroscopic synovectomy is a safe and successful procedure in ankle joints affected by RA. The best clinical outcomes are achieved when the procedure is performed early in the disease course and when there is no evidence of cartilage degeneration. Level of Evidence Level IV, prognostic case series.