Abstract
Synovitis of the smaller hand joints leads to soft-tissue and bony affections. Radiologically Larsen/Dale/Eek (LDE) distinguish 6 stages of increasing destruction. Tendon ruptures, swan-neck and buttonhole deformities may occur. In early stages, when the ligament- and capsule structures require no balancing therapy, arthroscopic synovectomy may be indicated in order to prevent fast deteriorating of the joints and disability. We perform the endoscopic procedure in the MCP- and PIP-joints, when an oligoarticular situation is present or single digits are affected, provided that the surrounding soft tissues are intact, in LDE-stages 0 to 2/3. We use the laser additionally for completion of the synovectomy and for shrinking of the capsule.
Technically it is necessary to have an short optical device of 1. 0 diameter, miniaturised instruments, shaver and the laser at one’s disposal. The radial and the ulnar incision proximal to the joint are used.
A pilot study of 12 patients with an arthroscopic, laser-assisted synovectomy in 20 joints of various digits (LDE 0 – 2) are opposed to 10 patients with an open synovectomy of 24 joints. The follow-up-period amounts to 9 months (6 – 9). We have looked after the reccurrence rate, the time-lag until the patients are pain-free, the necessary rehabilitation measures, the progression of the LDE-stages, and the subjective judment of the patients.
Both groups had no recurrence of the synovitis in the joints cared for surgically. The period until the patients were free of complaints in the arthroscopic group amounts to 4 days, opposed to 10 days in the open surgery group. Radiologically both groups revealed no further bony destruction according to LDE. 12 physiotherapy treatments after open synovectomy are twice the amount needed for the endoscopic group. This is true also for the time away from work: 14 days against 7 days. The arthroscopically treated patients remark favorably the discrete scars, the relatively pain-free perioperative period, low tissue trauma, quick rehabilitation. In open surgery the patients complain about large scars and long postoperative swelling of the joints.
We can not guarantee the completeness of the synovectomy in both procedures. The effect of the intraoperative lavage and the assistance of the laser are not entirely clear either. The arthroscopic synovectomy itself is technically easy to perform. Although in this pilot study we have small numbers only, the results suggest that arthroscopic synovectomy is low in tissue trauma, quick in rehabilitation, perfect in patient acceptance and followed by a very short time away from work compared to open surgery.
