Arthroscopic synovectomy in rheumatoid arthritis of the wrist

ABSTRACT

Almost all patients with rheumatoid arthritis have progressive destructive arthritis of the wrist involving all wrist compartments. Arthroscopic synovectomy of the wrist has been proposed as a therapeutic modality for rheumatoid wrist affection and in our study we evaluate its role and value in the management of such condition. Arthroscopic synovectomy of the wrist was undertaken on 17 patients [with 24 wrists] with rheumatoid arthritis after failure of splinting and medical treatment to control pain and swelling. All patients were classified as stage I and Stage II according to Steinbrocker's classification. The mean follow-up was 30 months [ranging from 18 to 54 months] Arthroscopic wrist synovectomy was performed using a 2.7mm 30° arthroscope and a motorized shaver system with 2.7mm and/or 3.5mm diameter synovial resector blades and medical treatment was continued. There were no complications. All patients showed persistent symptomatic improvement with decreased postoperative pain score after surgery and improved patient satisfaction although radiological progression of disease continued. Arthroscopic synovectomy of the wrist is a simple procedure with little postoperative that resulted in reliable symptorratic improvement however no positive impact on disease or radiological progression could be seen