Synovectomy

Synovectomy is a procedure to remove the synovium (synovial membrane) in one of your joints. A surgeon will remove some or all of the membrane and the joint fluid inside it.

Normally, synovial membranes play an important role in lubricating your joints and helping them move smoothly. But if an injury or health condition damages it, the synovium can cause pain and swelling inside a joint. Other treatments can usually manage symptoms and treat what’s causing them. But your provider may suggest joint synovectomy if other options haven’t worked.

You might need synovectomy to treat:

• Pigment villonodular synovitis (PVNS)
• Synovitis
• Rheumatoid arthritis
• Gout
• Other types of inflammatory arthritis

An orthopaedic surgeon can perform a synovectomy in any joint with a synovium, including your:

• Hips
• Knees
• Ankles
• Elbows
• Shoulders
• Wrists, hands and fingers

How should I prepare for synovectomy?

Your healthcare provider will suggest other treatments to manage the inflammation in your joint and treat what’s causing it. You’ll need to try a combination of medications and other nonsurgical treatments first.

But if the inflammation doesn’t get better after a few months, they might recommend a joint synovectomy. Having swelling inside a joint for a long time can eventually damage it.

Your surgeon will order imaging tests to take pictures of your joints. You may need X-rays, an MRI or an ultrasound.

Tell your surgeon which prescription and over-the-counter medicines you take. Make sure to include any supplements, too. They’ll let you know if you need to stop taking anything before your surgery.

Arrange transportation to and from your appointment ahead of time. Synovectomy is an outpatient procedure. That means you’ll be able to go home that day and won’t have to stay overnight in the hospital. But you won’t be able to drive yourself home.

What happens during this procedure?

Most synovectomies are arthroscopic surgeries. This is a minimally invasive surgery that follows these steps:

1. You’ll need general anesthesia to put you to sleep during the surgery so you won’t feel anything.
2. Your surgeon will make a few small cuts around your joint.
3. They’ll insert small surgical tools into the cuts to remove the synovium and/or repair damage inside your joint.
4. They’ll remove the tools and close the incisions.

Arthroscopy is the most common synovectomy technique, but there are also other options. Your surgeon may use:

• Open surgery: This is more traditional surgery, where your surgeon makes larger cuts that let them access the inside of your joint more directly.
• Radiation synovectomy: This is using radiation therapy to destroy a synovial membrane without surgery. It can be a good option if you have a condition like hemophilia that increases your risk of dangerous bleeding after surgery.

How long does this procedure take?

It varies. It depends on which joint needs a synovectomy and which technique your surgeon uses. Your care team can give you an estimate before your procedure date.

What are the potential benefits and risks of this procedure?

Safely and effectively relieving symptoms is the biggest benefit of synovectomy. Especially if you’ve been living with pain, stiffness or inflammation for a long time. It should be easier and more comfortable to use your joint once it heals.

Like all procedures, there are some risks. Complications are rare, but can include:

• Bleeding
• Infections
• Scarring that leads to new stiffness

What happens after synovectomy?

Your care team will move you to a recovery area after the procedure. If you needed anesthesia, they’ll make sure you wake up safely. They’ll monitor your pain level and make sure it’s OK for you to go home.

They’ll let you know which medications you can take to manage pain after your procedure, including how often you can take them.

What is the recovery time?

How long it takes you to recover depends on where you needed a synovectomy and which technique your surgeon used. Arthroscopy and radiation synovectomy have faster recovery times than open surgery. Big joints like your hips, knees and shoulders can take longer to heal than smaller ones.

Your surgeon will give you specific rehab and recovery instructions. They’ll tell you when it’s safe to start moving and using your joint. For example, if you had a synovectomy in your knee, you’ll probably need to start gently moving soon after you wake up. This can help prevent stiffness and help speed up recovery.

Your care team will help you understand how to do any movements or exercises safely. They’ll let you know when you should start physical therapy if it’s needed.

When should I call my healthcare provider?

Call your healthcare provider if you notice any symptoms of complications after your procedure, including:

• Severe pain that doesn’t get better after taking your medication
• Skin discoloration around your joint
• A feeling of heat or warmth
• Bleeding