Purpose
To evaluate the outcome of arthroscopic synovectomy of the ankle joint in patients
with early-stage rheumatoid arthritis (RA).
Methods
Between 2005 and 2009, 18 consecutive patients with RA involving the ankle underwent
arthroscopic synovectomy. Pain was measured using a visual analog scale (VAS), and
clinical outcome was determined by calculating the American Orthopaedic Foot and Ankle
Society (AOFAS) Ankle-Hindfoot Scale score with a mean follow-up of 5 years (60 months).
Assessments were performed preoperatively, at 6 and 12 months postoperatively, and
then yearly thereafter. Clinical success was defined as the absence of synovitis symptoms
or when patients demonstrated good or excellent outcomes (AOFAS Ankle-Hindfoot Scale
score ≥80) with >50% improvement in VAS score for pain. Demographic, laboratory, and
radiological variables were evaluated to determine possible factors predicting clinical
outcome.
Results
VAS and AOFAS scores were significantly improved at the final follow-up (60 months;
P < .0001). The greatest improvements in clinical scores were observed after 12 months;
thereafter, they steadily declined. Of the 18 patients examined, 14 (77.8%) were considered
to have had clinical success with no reintervention. Variables predictive of clinical
success were short duration of symptoms (P = .042) and minimal radiographic changes based on the Larsen grading system (P = .030).
Conclusions
Arthroscopic synovectomy is a safe and successful procedure in ankle joints affected
by RA. The best clinical outcomes are achieved when the procedure is performed early
in the disease course and when there is no evidence of cartilage degeneration.
Level of Evidence
Level IV, prognostic case series.
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Article info
Publication history
Published online: November 12, 2012
Accepted:
June 19,
2012
Received:
February 14,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
