Name of the Procedure:

Arthrotomy with Synovectomy, Ankle; including Tenosynovectomy

Summary

An arthrotomy with synovectomy is a surgical procedure that involves making an incision into the ankle joint to remove inflamed synovial tissue. This procedure also includes tenosynovectomy, which involves the removal of inflamed tendon sheath tissue.

Purpose

The procedure aims to alleviate pain and swelling in the ankle caused by conditions like chronic synovitis or tenosynovitis. By removing the inflamed tissues, it intends to improve joint function and reduce discomfort.

Indications

• Chronic ankle pain unresponsive to conservative treatments
• Swelling and excessive synovial fluid in the ankle joint
• Inflammation of the tendon sheath (tenosynovitis)
• Conditions such as rheumatoid arthritis or other inflammatory disorders affecting the ankle

Preparation

• Fasting for at least 6-8 hours before surgery
• Discontinuing certain medications, as advised by the physician
• Preoperative imaging studies like X-rays or MRIs
• Complete blood count (CBC) and other routine pre-surgical tests

Procedure Description

1. The patient is administered regional or general anesthesia.
2. A surgical incision is made over the ankle joint to access the synovial membrane and tendon sheaths.
3. The inflamed synovial and tendon sheath tissues are carefully removed using specialized surgical instruments.
4. The joint is irrigated to remove any debris.
5. The incision is closed with sutures, and a sterile dressing is applied.
6. The ankle may be immobilized with a splint or brace to aid in healing.

Duration

The procedure typically lasts about 1-2 hours.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Recurrence of symptoms
• Joint stiffness or reduced range of motion
• Blood clots

Benefits

• Reduction in pain and swelling
• Improved mobility and function of the ankle joint
• Decreased need for anti-inflammatory medications

Recovery

• Post-operative care includes elevation of the ankle, ice application, and prescribed pain medications.
• Physical therapy may be recommended to restore ankle function.
• Stitches are typically removed 10-14 days post-surgery.
• Complete recovery can take several weeks to a few months, depending on the individual.

Alternatives

• Non-surgical treatments such as physical therapy, medication, or corticosteroid injections
• Arthroscopic synovectomy, a less invasive procedure
• Pros and cons should be discussed with the healthcare provider to determine the most suitable option for the patient.

Patient Experience

• Patients will be under anesthesia during the procedure and will not feel pain.
• Post-surgery, pain and swelling are common but can be managed with medication and proper care.
• Patients might feel discomfort during initial recovery but will gradually experience relief from symptoms as healing progresses.