Written by Dynomed.com, Indianapolis, IN

If medication, exercise and physical therapy fail to greatly alleviate rheumatoid arthritis pain, you and your doctor may start to consider surgery. One of the surgical procedures available for rheumatoid arthritis is a synovectomy. Mostly used in the early stages of rheumatoid arthritis, a synovectomy removes inflamed lining tissue (synovium) from inside the affected joint. Most commonly, this procedure is used on knees, but it can be used on other joints such as the shoulder, wrist and elbow.

One of the benefits of this surgery is that it can alleviate rheumatoid arthritis pain in the joints by removing diseased tissue. The joint itself may also be saved from further damage. The synovium could grow back over time. However, this isn’t a permanent solution in most cases.  Be sure to discuss with your doctor the benefits and disadvantages of this surgery in your particular case.

Before Surgery

Before your synovectomy, you will need to have a thorough medical evaluation by your physician. Your doctor may also want to make sure you do not have any infections, such as a urinary tract infection or an abscessed tooth. In addition, you will need to stop taking anti-inflammatory drugs at least a week prior to the surgery. Anti-inflammatory drugs increase the risk of bleeding and infection. Your doctor may also order X-rays or an MRI to look at the joint prior to surgery.

If possible, you should be in the best physical shape you can be in before the synovectomy surgery. Talk to your doctor about your diet to find out if you are getting proper nutrition and pre-surgery exercise.

Before going into the hospital, you should discuss post-surgery care with your doctor and your family. Arrangements for skilled nursing care should also be made before surgery. Physical and/or occupational therapists should also be consulted to set up treatment for you after your synovectomy.

Be sure to review any information given to you by your doctor before the surgery. He or she may provide you with videos or detailed brochures about what you can expect during and after the synovectomy.

During the Synovectomy Surgery for Rheumatoid Arthritis

You will be given either a local or general anesthetic depending on your situation and your doctor’s advice. In many cases, you may be able to go home the same day or you may stay in the hospital for one to two days.

The surgeon will enter the joint through a small incision with an arthroscope, a narrow tube with a light at the end of it that is connected to a television. The arthroscope allows the doctor to see inside the joint to remove the diseased tissue. The surgeon’s team may pump a sterile saline solution into the joint in order to clean it. Air may also be pumped in to expand the joint space, allowing the surgeon to see easily inside of the joint.

Using the arthroscope, the surgeon will remove the diseased synovium with small surgical tools and suction equipment. While inside the joint, the surgeon will also look for any other problems such as further damage to the tissues or cartilage and floating bits of debris.

After Synovectomy

A synovectomy requires you to go through physical therapy and use medications for pain management. Immediately after the surgery, you will likely have a sling, if it was your shoulder, wrist or elbow that was operated on, or a splint or brace if it was your knee.  If you have a sling, it may be removed for periods of time as the healing occurs.  Your doctor may prescribe antibiotics in order to prevent infection and/or pain medications.

Physical therapy after synovectomy consists of range of motion exercises and strength building. A physical therapist or doctor will help guide you through your rehabilitation. Physical therapy may be uncomfortable or even painful at first, but it is essential to regaining your strength and range of motion.

There are possible complications with synovectomy. As mentioned before, the synovium may grow back and, in rare cases, you may get a blood clot. Some people may have a bad reaction to the anesthesia.  Be sure to tell your doctor about any increase in pain or swelling you feel after you go home and if you are losing range of motion. If you feel very tired or have a fever, an infection may have set in. Be sure to contact your doctor if this happens.