Article

Synovectomy is an effective procedure for management of
the rheumatoid elbow at radiographically early stages (Larsen grades 1 and 2).
However, its efficacy for advanced stages (Larsen grades 3-5) is controversial.
We investigated the outcome of synovectomy for advanced stages of the rheumatoid
elbow. Methods Between May 1985 and September 1994, synovectomy was performed for
67 rheumatoid elbows in 59 patients (mean age 52 (26-72) years, 54 women). 3
elbows (3 patients) were lost to follow-up after mean 15 (10-23) years. Thus, 64
elbows were evaluated clinically and radiographically.
Results : The mean Mayo
elbow performance score (MEPS) improved from 42 (15-75) points preoperatively to
78 (45-100) points at the final follow-up examination. In cases of Larsen grade
5, the mean MEPS at final follow-up examination (69 points) was lower than those
of Larsen grade 3 and 4 cases (80 and 79 points, respectively) (p < 0.01).
Recurrence of synovitis was obvious in 20/67 elbows. 12 cases had a total elbow
arthroplasty mean 13 years after the synovectomy.
The 10-year, 15-year, and
20-year survival rates were 97%, 75%, and 70%, respectively. Interpretation Our
findings suggest that synovectomy for the rheumatoid elbow gives a good long-term
outcome for radiographically judged destroyed joints of Larsen grades 3-4.

Langue : ANGLAIS