Name of the Procedure:

Arthrotomy with Synovectomy, Ankle
Common Name(s): Open Joint Surgery with Synovial Membrane Removal, Ankle Arthrotomy.

Summary

Arthrotomy with synovectomy of the ankle is a surgical procedure where an incision is made into the ankle joint to remove inflamed or diseased synovial tissue. It aims to relieve pain and improve joint function.

Purpose

This procedure addresses chronic inflammation, pain, and joint damage caused by conditions like rheumatoid arthritis or other synovial diseases. The goal is to reduce pain, improve joint mobility, and prevent further joint damage.

Indications

• Persistent ankle pain and swelling unresponsive to medication
• Limited joint movement
• Chronic synovitis
• Conditions like rheumatoid arthritis, gout, or tuberculosis of the joint
• Synovial hypertrophy

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to current medications as advised by the healthcare provider.
• Pre-operative blood tests, imaging studies (like MRI or X-rays), and physical examination.

Procedure Description

1. Anesthesia: The procedure is typically performed under general or regional anesthesia.
2. Incision: An incision is made over the ankle to access the joint.
3. Joint Opening: The joint capsule is carefully opened.
4. Synovectomy: The diseased synovial tissue is identified and removed using surgical instruments.
5. Joint Inspection: The surgeon may inspect and treat other areas within the joint if needed.
6. Closure: The joint capsule and skin are sutured closed.

Tools: Scalpels, retractors, scissors, suction devices, and possibly an arthroscope.

Duration

The procedure typically takes 1 to 2 hours.

Setting

It is usually performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon or foot and ankle specialist
• Operating room nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Ankle stiffness and limited mobility
• Blood clots
• Nerve or blood vessel damage
• Anesthesia-related complications

Benefits

• Pain relief and reduction in swelling
• Improved joint function and mobility
• Prevention of further joint damage
• Typically, benefits can be noticed within weeks to months post-surgery.

Recovery

• Initial immobilization with a brace or splint for 1-2 weeks
• Pain management with prescribed medications
• Physical therapy to regain strength and mobility
• Stitches removal in about 10-14 days, if non-dissolvable
• Full recovery may take several weeks to a few months

Alternatives

• Conservative treatments like medications, physical therapy, and joint injections
• Arthroscopic synovectomy (less invasive)
• Pros: Non-surgical options have lower risk but may be less effective for severe cases. Arthroscopy has a quicker recovery but may not be suitable for extensive disease.

Patient Experience

• During the procedure, the patient will be under anesthesia and not feel pain.
• Post-surgery, there may be pain and swelling around the ankle, manageable with medications.
• Elevation and ice packs may be recommended for comfort.
• Gradual return to activities as advised by the surgeon and physical therapist.