Office-based arthroscopic synovectomy of the wrist in rheumatoid arthritis.

We present an office-based technique for performing arthroscopic synovectomy of the wrist in patients with rheumatoid arthritis. Intra-articular anesthesia as well as subcutaneous portal anesthesia are used. Standard portals are used in the radial carpal and midcarpal joints. Standard instrumentation is used and the synovectomy is accomplished using a motorized shaver. We performed 30 procedures in 21 patients: 15 complete synovectomies, 3 radioulnar carpal synovectomies because of only limited disease, and 12 limited synovectomies because these patients were participants in a clinical trial and required only limited synovectomy for investigational purposes. There were no complications. Office-based arthroscopic synovectomy of the wrist in patients with refractory rheumatoid arthritis can be performed safety and effectively. This technique is useful in both a clinical as well as a research setting.

Arthroscopic synovectomy of the metacarpophalangeal joint in refractory rheumatoid arthritis: a technique.

Arthroscopic synovectomy was performed on 29 metacarpophalangeal joints belonging to 21 patients with refractory rheumatoid arthritis. This article describes the method of anesthesia, landmarks, and operative technique. Short-term (12-month) results and patient satisfaction have been excellent. No complications were noted. We conclude that arthroscopic synovectomy of the metacarpophalangeal joints in patients with refractory rheumatoid arthritis can be performed safely and effectively. Possibilities for improvement of the technique as well as possible uses of the technique in research are discussed.

The holmium YAG laser in office based arthroscopy of the knee: comparison with standard interventional instruments in patients with arthritis.

OBJECTIVE: To confirm the feasibility of laser assisted technology in an office based rheumatology practice and to compare selected outcome variables with those of conventional arthroscopic cutting tools. METHODS: A prospective analysis of 70 office based arthroscopies on 70 patients with knee arthritis over an 8 month period. All patients met specific criteria for office based arthroscopy. Thirty-six patients had interventions with conventional cutting tools and 34 patients had interventions with a 40 watt holmium YAG laser. Variables assessed included procedure time, length of recuperative period, and postprocedural pain. RESULTS: Laser assisted arthroscopy was performed in 34 cases without side effects or complications. Patients who received laser treatment had a shorter recuperative period, less postprocedural pain, and fewer hemarthroses than patients treated with conventional methods. CONCLUSION: While recognizing the shortcomings and possible complications associated with laser surgery, we conclude that laser use in an office setting is not only feasible but may in the future be an excellent method for office based arthroscopic treatment of the arthritic knee.

Office-based Arthroscopy. Evolution of the Procedure.

A review of the results of the second 100 cases of office-based arthroscopy is presented. The major difference between the first 100 cases and the present group has been the change from a diagnostic mode to an interventional mode. This transition has been facilitated by the use of a 2.7-mm, 30-degree oblique arthroscope along with a computerized fluid management system. The indications included knee pain refractory to conservative measures that included rest, exercise, physical therapy, anti-inflammatory medication, monoarticular arthritis of uncertain etiology, and the abrupt onset of locking suggestive of an acute mechanical problem. The pathology found at the time of arthroscopy for the most part confirmed the clinical impression; however, there were several instances in which the diagnosis was changed and the subsequent medical therapy was changed accordingly. The clinical response to arthroscopic intervention generally paralleled what has been reported by others, with important and prolonged relief of pain in most cases. Three major complications (septic joint, cellulitis, and thrombophlebitis) were seen. Strategies are suggested to avoid these. Arthroscopy is valuable in establishing, confirming, or possibly negating previous diagnostic impressions. More importantly, the ability to perform arthroscopic intervention in the office in patients with arthritis adds another therapeutic weapon to the armamentarium of clinical rheumatologists.