Name of the Procedure:

Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (e.g., medial or lateral)

Summary

Arthroscopic knee surgery for a major synovectomy involves the removal of inflamed synovial tissue from two or more compartments of the knee, typically the medial and lateral compartments. This minimally invasive procedure is performed using a small camera and surgical instruments through tiny incisions in the knee joint.

Purpose

This procedure addresses chronic knee pain and swelling due to synovitis, which is the inflammation of the synovial membrane lining the joint. The primary goal is to alleviate pain, reduce swelling, and improve knee function by removing the inflamed tissue.

Indications

• Chronic knee pain and swelling unresponsive to conservative treatments.
• Persistent synovitis due to conditions such as rheumatoid arthritis, psoriatic arthritis, or other inflammatory arthropathies.
• Recurrent knee effusions (excess fluid accumulation).
• Decreased knee mobility and function due to synovial inflammation.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to regular medications, especially blood thinners, as advised by the physician.
• Preoperative assessments, including blood tests, imaging studies (e.g., MRI, X-rays), and a physical examination.

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. Small incisions are made around the knee joint.
3. An arthroscope (a small camera) is inserted into the knee to visualize the joint.
4. Specialized surgical instruments are introduced to remove the inflamed synovial tissue from the targeted compartments (medial and lateral).
5. The arthroscope and instruments are withdrawn, and the incisions are closed with sutures or surgical tape.
6. A sterile dressing is applied to the surgical site.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity.

Setting

The procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon skilled in arthroscopic procedures.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and operating room staff.

Risks and Complications

• Infection at the surgical site.
• Blood clots.
• Knee stiffness or reduced range of motion.
• Persistent pain or swelling.
• Injury to surrounding structures (e.g., nerves, blood vessels).

Benefits

• Reduction in knee pain and swelling.
• Improved knee joint function and mobility.
• Fast recovery time compared to open surgery.
• Minimized surgical scars.

Recovery

• The patient may be advised to use crutches or a knee brace initially.
• Physical therapy may be recommended to restore knee function.
• Activities and weight-bearing might be restricted for a few weeks.
• Follow-up appointments to monitor healing and progress.

Alternatives

• Conservative treatments such as medication, physical therapy, and corticosteroid injections.
• Oral or injectable disease-modifying antirheumatic drugs (DMARDs) for underlying inflammatory conditions.
• Open synovectomy or more extensive surgical options if arthroscopy is not feasible.

Patient Experience

• Mild to moderate pain managed with prescribed medication.
• Swelling and discomfort, typically managed with ice packs and elevation.
• Instructions for wound care and signs of potential complications to watch for.
• Gradual return to normal activities as healing progresses.