Name of the Procedure:

Synovectomy; Metatarsophalangeal Joint, Each
Common Name(s): Synovectomy of the toe joint, MTP joint synovectomy
Medical Term: Metatarsophalangeal Joint Synovectomy

Summary

A synovectomy of the metatarsophalangeal (MTP) joint is a surgical procedure to remove part or all of the synovial membrane surrounding the joint where the toe meets the foot. This can alleviate pain and inflammation often associated with arthritis or other joint conditions.

Purpose

This procedure addresses:

• Rheumatoid arthritis
• Osteoarthritis
• Synovial membrane inflammation The goal is to reduce pain, improve joint function, and halt or slow the progression of joint damage.

Indications

• Persistent joint pain and swelling that does not respond to non-surgical treatments
• Limited range of motion due to inflammation
• Diagnosed rheumatoid arthritis affecting the MTP joint
• Synovitis or chronic inflammation of the synovial membrane

Preparation

• Fasting for at least 6-8 hours before surgery
• Adjustments in medications, particularly blood thinners, as advised by the healthcare provider
• Pre-operative blood tests and imaging studies, such as X-rays or MRIs, to assess joint damage

Procedure Description

1. Administration of regional anesthesia or general anesthesia to ensure the patient does not feel pain during the procedure.
2. Making a small incision over the affected MTP joint.
3. Exposing the joint to remove the inflamed or damaged synovial membrane.
4. Inspecting the joint for other potential damage and addressing it, if necessary.
5. Closing the incision with sutures and applying a sterile dressing.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon or foot and ankle specialist
• Anesthesiologist or nurse anesthetist
• Surgical nurses and support staff

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Stiffness in the joint
• Incomplete pain relief
• Recurrence of synovitis

Benefits

• Reduction in pain and inflammation
• Improved joint mobility and function
• Prevention of further joint damage
• Improvement may be noticed within weeks after surgery

Recovery

• Keeping the foot elevated to reduce swelling
• Pain management with prescribed medications
• Physical therapy to regain joint function
• Avoiding weight-bearing activities for a few weeks
• Follow-up appointments for monitoring healing and removal of sutures

Alternatives

• Non-surgical options like physical therapy, medications (NSAIDs, corticosteroids), and joint injections
• Arthroscopy as a minimally invasive surgical option
• Pros of alternatives: Less invasive, shorter recovery time
• Cons of alternatives: May be less effective for severe cases

Patient Experience

• During the procedure: Under anesthesia, will not feel pain
• After the procedure: May experience swelling, soreness, and mild pain
• Pain management: Prescription painkillers and anti-inflammatory medications
• Comfort measures: Ice packs, elevation of the foot, use of crutches to avoid weight-bearing