The knee joint is the largest joint in the human body. It is a complex joint, functionally built of two parts (compartments), often referred to as joints:
a femoral joint formed by the articular surfaces of the femoral condyles and the articular surfaces of the upper tibia, partially separated by two connective-tissue menisci that align the articular surfaces with each other during movements of the knee joint;
the patellofemoral joint, which includes the articular surface of the patella on its posterior side and the anterior articular surface of the distal end of the femur.
The knee is reinforced with several external ligaments and additionally very strong internal ligaments - anterior and posterior cruciate ligaments. The space of the femoral and patellofemoral joints is limited by the articular capsule. It is made of two layers:
external, made up of connective tissue fibers (fibrous capsule), which are a durable cover for the joint, which together with ligaments ensures its stability;
inner - synovial membrane made of synovial cells producing synovial fluid called synovial fluid, which in the right amount facilitates movement in the joint, ensures good glide of the articular surfaces in relation to each other and proper nutrition of the articular cartilage, thus preventing its wear.
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Synovitis - causes and symptoms
The synovial membrane is a very delicate structure which, as a result of previous knee injuries or various rheumatic diseases (including rheumatoid arthritis, juvenile idiopathic arthritis, gout, lupus erythematosus and systemic sclerosis), or in tumors and tuberculosis, can overgrow many times its volume and hence its secretory activity. This leads to an overproduction of synovial fluid, which as a result of this process has an abnormal chemical composition. In this situation, its value as a substance facilitating the glide of the articular surfaces and as a nutrient for the articular cartilage is significantly reduced.
The pathological changes occurring in the synovium can be divided, depending on the duration of inflammation, into 3 groups:
the early period, characterized by thickening and swelling of the synovium and an increase in synovial fluid;
advanced period - significant synovial hyperplasia;
the late period, accompanied by synovial hypertrophy with its numerous and large convexities between the working articular surfaces, the presence of calcifications and fibrosis, and the presence of free bodies in the synovial fluid.
Changes in the knee joint, resulting from synovitis, are accompanied by severe pain and a reduction in the physiological range of motion in the joint. There is palpation, there may be warming of the affected area and an increase in the outline of the joint, which indicates its swelling. Inflammation can also cause general weakness and a fever.
Synovitis - diagnosis
The examination that is performed by an orthopedic surgeon in the case of synovitis in the first place is an ultrasound examination (ultrasound of the knee). It allows you to determine whether the joint has the correct amount of synovial fluid and whether the joint membrane is hypertrophied and hyperemic. Another examination that can illustrate this is the MRI of the knee, but due to the cost and waiting time, it is very rarely performed in the diagnosis of inflammation.
Synovitis - conservative treatment
In patients suffering from synovitis, the first stage is conservative treatment consisting of pharmacotherapy, physical therapy and limiting the activity of movement in the joint and relieving it. Painkillers and anti-inflammatory drugs are administered orally or topically, but also in advanced cases under ultrasound guidance directly into the joint cavity. In addition, physiotherapy treatments are performed to reduce inflammation, pain and swelling (e.g. cryotherapy, ultrasound, laser, iontophoresis with an anti-inflammatory drug).
Attempts at conservative treatment of synovitis are often successful, but if this form of treatment fails, surgery may be necessary.
Synovitis - surgical treatment
The indications for surgical treatment of synovitis of the knee are: joint destruction, excessive synovial hyperplasia that does not go away despite chronic pharmacological treatment, any pressure on the nerves and inflammation within the tendons, which may be associated with their damage. Joint inflammation, restriction of mobility and pain alone are not absolute indications for surgical treatment, and the decision about which method of treatment will be the most appropriate is made together with the patient after presenting all the pros and cons.
The surgical procedure performed in the case of synovitis of the knee joint is a synovectomy of the knee consisting of possibly complete removal of the overgrown synovial membrane. Synovectomy can be performed in two ways: arthroscopically or classically (open method).
Arthroscopic synovectomy is a minimally invasive diagnostic and operational technique, during which the arthroscope is inserted into the joint through small incisions in its vicinity, which has a direct impact on reducing postoperative pain, shortening the hospital stay, reducing the risk of complications and, above all, faster return of the patient. to function normally without pain or restriction.
Arthroscopic synovectomy of the knee
Arthroscopic synovectomy of the knee is a surgical procedure involving the removal of the diseased synovial membrane. The purpose of this procedure is to eliminate inflammation in the joint by removing the synovium, which leads to the reduction of joint swelling and pain.
Arthroscopic synovectomy of the knee - rehabilitation after surgery
Rehabilitation procedure after arthroscopic synovectomy of the knee joint involves an individual rehabilitation plan and the selection of appropriate rehabilitation exercises for the stage of tissue healing.
Postoperative management in the first phase (up to 2 weeks after the procedure) aims to control pain, inflammation and exudate by applying cold compresses for 7 to 10 minutes every 2 hours and partially relieving the operated limb. It is recommended to perform passive and self-assisted movements in the knee joint in the first days after the procedure to restore the normal physiological range of motion and isometric exercises of the quadriceps muscle. In the following days, knee bending and straightening exercises should be introduced in closed kinematic chains and proprioception exercises for the knee joint. In this phase, you should also learn to walk correctly on crutches with partial relief of the limb.
In the next stage, it is very important to regain neuromuscular control of the knee joint. It is necessary to continue to gradually increase the range of motion in the knee and to continue the exercises from the previous stage with the additional use of progressive resistance. In addition, the emphasis is placed on increasing the muscle strength necessary for the proper functioning and maintaining stabilization and the correct axis of the lower limb, restoring physiological mobility and obtaining the correct gait pattern on a varied surface. Obtaining the full range of motion in the joint and adequate muscle strength allows the patient to return to the activities of everyday life.
The total rehabilitation time for the patient to fully heal after arthroscopic synovectomy is approximately 2-6 months.
Isotope synovectomy of the knee
Another method of removing the synovial membrane is isotope radiosynovectomy. Rather, it is performed in elderly people who have contraindications to surgery.
This procedure consists in removing excess inflammatory fluid from the knee and intra-articular injection of a radioisotope solution, the purpose of which is to remove the synovial membrane by causing its necrosis and fibrosis.
The indications for a synovectomy are, among others rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, osteoarthritis of the knee, and recurrent exudative arthritis of the knee.
The condition for the application of this type of treatment is an uninterrupted joint capsule that prevents the outflow of the isotope. These procedures are performed in nuclear medicine facilities, usually with ultrasound control of the knee. After administration of the isotope, it is necessary to immobilize the joint for several days in order to prevent the leakage of the isotope, which could result in necrosis of the subcutaneous tissue and skin, which would be associated with long-term treatment.
The visible therapeutic effect of isotope synovectomy is achieved about 3-4 weeks after administration of the isotope. There is a significant reduction in pain, swelling and increased mobility of the joint. The maximum post-treatment effect is obtained after about 6 months. This time is necessary for the destruction of the hypertrophied, inflamed synovium and regeneration of the healthy one necessary for the normal functioning of the joint.
Radiosynovectomy is a minimally invasive procedure and, unlike surgical procedures, it does not require rehabilitation after the procedure, it is performed on an outpatient basis, and the patient returns home and normal life after the procedure. It is a procedure that is safe for the patient himself and his surroundings. There is no fear of isotope radiation outside the pond.
Application of isotope synovectomy of the knee:
before invasive procedures, such as, for example, arthroscopic synovectomy of the knee to eliminate the need for surgery;
a few weeks after arthroscopic or open synovectomy to enhance the therapeutic effect of surgery;
in the case of joint inflammation after knee prosthesis insertion.
Important information
| Duration of the procedure (depending on the method) | 75 - 120 minutes |
| Tests required for surgery | basic - preparation for surgery tab |
| Anesthesia | subarachnoid |
| Hospital stay | 8 - 16 hours after surgery |
| A period of significant dysfunction | 2 - 3 weeks |
| A period of limited dysfunction | 4 - 12 weeks |
| Removal of stitches - first visit | 12 - 16 days after surgery |
| Change of dressings | every 3 - 4 days |
| Contraindications to the procedure | set individually |
Frequently asked questions about the knee synovectomy:
Arthroscopic synovectomy of the knee is a surgical procedure involving the partial or complete removal of the diseased and enlarged synovial membrane. The purpose of this procedure is to eliminate inflammation in the joint by removing the synovium, which leads to the reduction of joint swelling and pain. The total rehabilitation time for the patient to fully heal and return to full activity after arthroscopic synovectomy is approximately 2 - 6 months.
The synovial membrane is a very delicate structure. As a result of previous knee injuries or various rheumatic diseases, i.e. rheumatoid arthritis, juvenile idiopathic arthritis, gout, lupus erythematosus and systemic sclerosis, or in tumors and tuberculosis, it may overgrow, thus increasing its secretory activity. This leads to an overproduction of synovial fluid with an abnormal chemical composition, so its value as a substance facilitating the glide of the articular surfaces and nourishing the articular cartilage is significantly reduced, which leads to generalized synovitis.
The indication for radioisotope synovectomy is exudative synovitis of the knee joint, which occurs, inter alia, in in the course of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, osteoarthritis of the knee and recurrent exudative inflammation of the knee.
