Your synovium, or synovial membrane, is a thin membrane that lines the inside of joints like your elbow, knee, and shoulder. If you have psoriatic arthritis (PsA), this membrane may get thick and inflamed.
You may need surgery to remove the synovium in the affected joint with a procedure called a synovectomy. When a surgeon does the surgery arthroscopically (using a tiny camera attached to a narrow tube), it’s called an arthroscopic synovectomy.
Why Do I Need an Arthroscopic Synovectomy?
When your synovium gets inflamed, it makes too much of a lubricating oil called synovial fluid. This fluid contains an enzyme that, if there’s too much of it, eats away at your joint’s cartilage.
This may cause severe pain and limit your range of motion. It can make it hard for you to get around and do daily activities.
Your doctor may recommend removing the inflamed joint lining. You may need a partial or complete synovectomy, depending on how much tissue needs to be removed.
How Is Arthroscopic Synovectomy Different From Other Synovectomies?
There are two ways to do this type of surgery: through open surgery or arthroscopically.
With an arthroscopic synovectomy, your doctor uses an arthroscope, which is a small tube with lenses, a small video camera, and light. It’s connected to a video system that shows your doctor what’s happening.
During an arthroscopy, your doctor will make small cuts, or incisions, in your skin to put in the small instruments. Then they’ll see pictures from the small camera on a larger screen. This helps guide them through the procedure.
What Are the Benefits of an Arthroscopic Synovectomy?
An arthroscopic synovectomy has several advantages over open surgery, including:
- Faster recovery
- Less pain during recovery
- Less scarring
- Less damage to soft tissue
- Smaller incisions
Since this type of surgery takes away the need for a large incision, it’s especially helpful if you need to have another procedure. It may also help your doctor remove more synovial tissue at a time.
Is an Arthroscopic Synovectomy Safe?
Yes. It’s a safe procedure that can cut down on inflammation in your joint and help your range of motion.
Research is limited but suggests that when you combine an arthroscopic synovectomy with drug therapy, it eases symptoms.
Early studies suggest an arthroscopic synovectomy may:
- Delay the need for further treatment such as a total knee replacement
- Lessen pain
- Slow the progression of PsA
What Are the Risks of Arthroscopic Synovectomy?
As with all surgeries, there are potential risks. Possible risks of arthroscopic synovectomy include:
- Bleeding into the joint
- Blood clots
- Blood vessel damage
- Bone surface damage
- Cartilage damage
- Ligament damage
- Nerve damage
- Stiffness or weakness after the procedure
It’s possible that surgery won’t relieve your symptoms. Another risk is that your synovium may grow back, which means you may need more surgery.
Who Is an Arthroscopic Synovectomy Best For?
If you need a synovectomy, your doctor will recommend open surgery or an arthroscopic synovectomy, depending on which joint is affected.
An arthroscopic synovectomy works better for some joints than for others. For example, if you have severe pain and inflammation in your knee, they may choose to do it arthroscopically.
Another reason your doctor may choose an arthroscopic synovectomy is to lessen the trauma from surgery.
Who Performs an Arthroscopic Synovectomy?
You’ll have a team of providers to oversee your arthroscopic synovectomy. Your team may include:
- Orthopedic surgeons
How Is an Arthroscopic Synovectomy Done?
These are the steps involved in an arthroscopic synovectomy:
- Your doctor gives you anesthesia.
- They make a few small incisions near your joint.
- They put the arthroscope in one incision, to see the inside of your joint.
- They put other surgical instruments in the other incisions to remove the inflamed synovium.
- They insert a sterile liquid in your joint to clear out debris.
- They remove the arthroscope and other instruments.
- They cover your incisions with bandages.
How Do I Prepare for an Arthroscopic Synovectomy?
Your team of doctors will tell you what to do before your surgery. They may tell you to:
- Avoid medications and supplements that increase your chances of bleeding.
- Don’t eat or drink for 6-12 hours before your procedure.
- Wear loose, comfortable clothing and shoes so you can get dressed easily after surgery.
- Arrange for someone to pick you up after the procedure.
What Happens After an Arthroscopic Synovectomy?
Your doctors will share instructions for what to do after your surgery. They may ask you to do the following:
- Avoid movements like carrying, lifting, pushing, pulling, and twisting.
- Use heat or cold therapy to help with pain and swelling.
- Limit activity.
- Don’t shower for 48 hours.
- Take pain medication.
- Get rehabilitation for the affected joint as soon as possible.
You may have stiffness, pain, and swelling for 2-4 days. You may have bandages for a few days. If you have tape strips on the wound, leave them in place for 7-10 days. You may get a removable cast to limit your mobility.
Call your doctor if:
- Pain and swelling last more than 2-4 days.
- You have a fever over 101.5 F.
- Your pain gets worse.
- You notice discharge or drainage from the incision after 24 hours.
Your doctor will schedule a follow-up appointment to see how you’re doing after the surgery. They’ll do an exam, talk about the procedure, and create a rehabilitation plan.
What’s the Recovery Like?
Your recovery may depend on which joint is involved, how large your incisions are, and where your incisions are on the joint.
You may take medication to ease inflammation and to protect your other joints.
Your doctor may recommend starting physical therapy as soon as 1-2 days after your surgery. This helps you get your joint flexibility back.
If your surgery is for a large joint, like your knee, your doctor will recommend range-of-motion exercises to help it function again. They may also suggest that you use a continuous passive motion machine (CPM) to help with recovery. This is a device that moves your injured joint through a full range of motion for you. Your insurance or Medicare may cover the costs.
Your physical therapist will show you how to move your joint the right way.
Does an Arthroscopic Synovectomy Work?
Yes. You may feel a lot less pain and see a big improvement in how your joint functions.
When Is an Open Synovectomy a Better Option?
Your doctor may recommend open surgery if an arthroscopic synovectomy would take a long time or be harder to perform. It often depends on which joint is affected.