THU0065 Results of treatment of arthroscopic and traditional synovectomy of the knee joint in rheumatoid arthritis

Abstract

Background: Rheumatoid arthritis is a systemic inflammatory autoimmune disease of connective tissue with a predominant joint injury that occurs at any age, more often in women. It is characterised by a chronic course with periods of exacerbations and remissions Objectives: To evaluate the results of arthroscopic and traditional synovectomy of the knee joint in patients with rheumatoid arthritis Methods: The study involved 48 patients, 29 of them were women and 19 men, aged from 25 to 65 years old, who had a chronic synovitis of the knee joints. It was implemented at the department of traumatology, orthopaedics and GPH with neurosurgery of Tashkent Medical Academy and 1-Republic Clinical Hospital. In all patients, on the background of basic therapy and intraarticular injections of SCS, a persistent recurrent synovitis was formed within a few months. Sixteen patients underwent sinocapsullectomy (SCE) with the traditional method. 32 patients underwent arthroscopic synovectomy (ASE), for which the standard basic arthroscopic technique Dyonics (Smith and Nephew) was used. The functional condition of the knee joint before and after the operation was assessed using the KOOS scale (Knee and Osteoarthritis Outcome Score) Results: The study showed that movements in the operated joint were allowed 3-5 hours after the operation, from the first day, isometric exercises were prescribed, active movements in the knee joint before the onset of pain. Results of treatment in terms of up to 3 months were tracked in all 48 patients. The degree of intraarticular changes determined by arthroscopy was evaluated according to the Outerbridge classification. In patients after SCE, pain in the joint, limiting the amplitude of motion, crunching during movement were noted. After ASE, there was a significant improvement in the function and condition of the knee joint: patients could walk for longer distances without additional support, did not experience discomfort while walking the stairs, complaints of pain, and no swelling. Repeated ASE with tunnelling was required in 2 patients with grade III chondromalacia Conclusions: Thus, the SCE of the knee is indicated if the conservative treatment of recurrent synovitis in RA is unsuccessful for a long time. The ASE should be performed in the early stages of the RA, which drastically reduces the activity of the pathological process, makes it possible to maintain the functional capacity of the joint, and the timely adequate administration of the basic therapy allows the maximum achieved long-term functional result to be maintained for the longest time and reduces the risk of relapse and the need for repeated operations.