Abstract
Aim: To test the hypothesis that open surgical synovectomy of the knee results in better long-term control of chronic inflammatory synovitis of the knee than arthroscopic synovectomy.
Method: To test this hypothesis a prospective clinical trial was carried out involving three groups of patients:- In Group I (22 cases in 18 patients) arthroscopic synovectomy was performed by a surgeon experienced in arthroscopy (Bartlett). In Group II (15 cases in 11 patients) open surgical synovectomy / debridement was performed (Rush). In Group III (10 cases in seven patients) arthroscopic lavage was carried without synovectomy (Rush) and this acted as a “control” group. The patients were followed up for some 10 years. At the final review the clinical and functional scores were recorded using the H.S.S. knee score system. There are obvious problems in comparing two or three groups of patients from two separate units and these are discussed.
Results: The results showed that in both groups (i.e. Groups I & II) there was a significant shift to the right in the clinical and functional scores. This did not occur in the “control” group. In Group I, two cases out of 22 came to total knee replacement. In Group II, four cases out of 15 and in Group III, five cases out of 10 came to knee replacement.
Conclusions: It was concluded that knee synovectomy was a worthwhile procedure and that arthroscopic synovectomy was just as good and probably better than open surgical synovectomy but it needs to be done early and by a surgeon with experience in carrying out this difficult procedure.
The abstracts were prepared by Professor A. J. Thurston. Correspondence should be addressed to him at the Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
