Today's News

Saturday, February 24, 1996

Report: Open synovectomy better for arthritis in elbow

Using open synovectomy and radial head extension instead of arthroscopic synovectomy to treat rheumatoid arthritis of the elbow

produces better long-term results, even though arthroscopy is less invasive and has a reduced rehabilitation time. These findings were presented Friday in scientific paper 153.

Between January 1988 and June 1992 a total of 11 consecutive patients from the Mayo Clinic, Rochester, Minn., underwent 14 arthroscopic synovectomies of the elbow for rheumatoid arthritis. At three months postoperatively, eight elbows had no pain and six had only mild pain. Overall, 93 percent of the cases initially achieved excellent or good results.

"Thirteen of the 14 surgeries resulted in the patients having a significant improvement in pain (an average of 20 months) and range of motion in flexion increased after six of the arthroscopic procedures," said Bernard F. Morrey, MD, professor and chairman, department of orthopaedics, at the Mayo Clinic and Mayo Foundation. "These results are similar to that of open synovectomy."

However in the final follow-up (an average of 42 months), only 57 percent of the patients who had arthroscopy maintained excellent or good results. When pain grading and functional scores were evaluated, the condition of eight elbows had deteriorated. Five elbows were pain free; four, mild pain; four, moderate pain; and one, severe pain. Four patients required subsequent total elbow arthroplasties for recurrence of symptoms.

Dr. Morrey noted that this study about the benefits of arthroscopic intervention was limited and there is much more data available on results of open procedures.

Co-author of the study with Dr. Morrey is Brian Lee, MD, department of orthopaedic surgery, Singapore General Hospital.

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