[Synovectomy of the knee joint in rheumatoid arthritis].

Excision of the diseased synovial membrane from the knee in rheumatoid arthritis was first established as a valuable procedure by Swett in 1923. Eleven of the twelve knees which he described showed a good result when reviewed up to two years later, and he stressed the importance of limiting the operation to patients with no joint destruction. Boon-Itt (1930) reported improvement in two-thirds of forty-two knees after synovectomy, and he related the poor results to the damage to articular cartilage already present at the time of operation. Less encouraging were reports by Inge (1938) and by Ghormley and Cameron (1941) who described improvement in only 50 per cent of knees. London (1955) attributed poor results after synovectomy either to operation on knees with a reduced joint space or to continuation of active rheumatoid disease : nevertheless, twelve out of his seventeen knees showed continued improvement when examined over two years after operation. In the past nine years there have been reports from numerous authors of good results in between 60 and 90 per cent of knees up to six years after operation (Mon and Ogawa 1963; Aidem and Baker 1964; Marmor 1966 ; Paradies 1969 ; Todd and Tkach 1969 ; Weinfeld 1969; Geens, Clayton, Leidholt, Smyth and Bartholomew 1969 ; Deodhar, Downie, Freeman, Dick, Nuki, Whaley and Buchanan 1970). Evaluation of the results of synovectomy of the knee after a longer interval has suggested that progressive deterioration in the quality of result occurs over the years (Gari#{233}py, Demers and Laurin 1966; Vainio 1966). Stevens and Whitefield (1966) found 90 per cent of knees with pain still relieved six months to three years after operation, and with loss of movement in only 18 per cent. The present study describes the findings in the same group of patients up to nine years after synovectomy.