Rheumatoid arthritis of the elbow: The results of synovectomy.

The elbow joints are often involved in rheumatoid arthritis but it has been suggested that such involvement is not commonly a major cause of disability in the upper limb (Merle d’Aubign#{233} and Delbarre 1969, Torgerson and Leach 1970). It is perhaps this belief that has led to the relatively infrequent use ofoperative treatment for rheumatoid arthritis ofthe elbow, except as a late “salvage” procedure. However, the extent of the problem may have been underestimated. In a recent study by the present authors, 25 per cent ofa hospital population of 225 patients suffering from rheumatoid arthritis had severe disability in one or both upper limbs resulting wholly or partly from disease of the elbow. Nearly half the patients in the whole group had pain in one or both elbows and only 28 per cent had no clinical evidence of elbow involvement. The results of synovectomy have been studied mostly in the knee. The short-term results are good, with relief of pain after 70 to 90 per cent of operations (Geens 1969). However, this could possibly be ascribed to a “placebo effect” (Mason 1969) and the long-term value of the procedure still awaits the results of prospective studies. Reports on synovectomy of other joints are less plentiful but the short-term results quoted are similar to those in the knee (Lipscomb 1965: Vahvanen 1968; Ellison, Kelly and Flatt 1971). Early references to elbow synovectomy were made by Swett (1929), Allison and Coonse (1929) and Smith-Petersen, Aufranc and Larson (1943). Lame and Vainio (1969) gave a preliminary report on ninety-two elbow synovectomies. The average duration of follow-up was one year and most of the patients had advanced changes in the joint before operation. Even so, the short-term results were encouraging, with complete or satisfactory relief of pain in three-quarters of their patients. Other authors who have reported similar results in smaller series include Wilkinson and Lowry(l965), Anderson and Heppenstall(l971), lnglis, Ranawat and Straub (1971), Peterson and Janes (1971), Wilson (1971) and Marmor (1972). The present paper is a study of the results of synovectomy of the elbow carried out at one centre over a period of seven years. It attempts to define the factors that influence the results and to determine whether the quality of the result deteriorates with time.