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Arthroscopic Surgery
By inserting a pencil-sized telescope called an arthroscope through a small incision in the skin, a surgeon or rheumatologist is able to look inside the joint without putting the patient through major surgery. Being able to see the inside joint structures helps the surgeon determine what conditions are creating problems. And, at the same time the surgeon is examining the inside of the joint, he or she can take a biopsy of tissue within the joint to confirm a diagnosis or perform simple corrective procedures such as removing damaged cartilage.
More extensive surgical procedures such as ligament and tendon repairs can also be performed through an arthroscope. Arthroscopic synovectomy, in which inflamed synovial lining is removed, is another common procedure.
Synovectomy
Synovectomy is the name of the procedure in which destructive synovitis is removed. This inflamed joint lining (synovium) is removed surgically to prevent it from damaging cartilage and other joint structures. Although very effective in reducing joint pain and swelling, synovectomy should not be viewed as providing a permanent cure because the synovium can grow back, and complete removal of all synovial tissue is not possible.
As discussed above, synovectomy can be performed through an arthroscope. This approach has an advantage over open surgical synovectomy in that it avoids cutting and opening the joint capsule surgically. For this reason, recovery from arthroscopic synovectomy is generally quite rapid.
Although it is more invasive, an open surgical synovectomy also has certain advantages. It provides the surgeon a better view of, and improved access into, the total joint, thereby facilitating thorough removal of the inflamed synovial tissue.
On the horizon are other forms of synovectomy which may be available. One is a form of laser synovectomy which is presently being developed. Using the arthroscope, the surgeon vaporizes the inflamed synovium with the laser. Care must be taken not to injure ligaments or underlying cartilage.
The second measure is radiation synovectomy. This form of therapy has been used extensively in Europe and in a few academic centers in the United States. The procedure consists of injecting a radioactive substance directly into the joint to eliminate synovitis. It has not been widely accepted in this country because of concerns about radioactive leakage from the joint. New forms of joint injection therapy are being developed, though, as researchers are trying to design a chemical that will react exclusively with rheumatoid synovium. This form of chemical synovectomy may be extremely effective if a chemical can be formulated to seek out and destroy only the destructive tissues while preserving the healthy and important ones.
*112/209/5*

TYPES OF SURGERY FOR TREATMENT OF RHEUMATOID ARTHRITIS: ARTHROSCOPIC SURGERY AND SYNOVECTOMYArthroscopic SurgeryBy inserting a pencil-sized telescope called an arthroscope through a small incision in the skin, a surgeon or rheumatologist is able to look inside the joint without putting the patient through major surgery. Being able to see the inside joint structures helps the surgeon determine what conditions are creating problems. And, at the same time the surgeon is examining the inside of the joint, he or she can take a biopsy of tissue within the joint to confirm a diagnosis or perform simple corrective procedures such as removing damaged cartilage.More extensive surgical procedures such as ligament and tendon repairs can also be performed through an arthroscope. Arthroscopic synovectomy, in which inflamed synovial lining is removed, is another common procedure.
SynovectomySynovectomy is the name of the procedure in which destructive synovitis is removed. This inflamed joint lining (synovium) is removed surgically to prevent it from damaging cartilage and other joint structures. Although very effective in reducing joint pain and swelling, synovectomy should not be viewed as providing a permanent cure because the synovium can grow back, and complete removal of all synovial tissue is not possible.As discussed above, synovectomy can be performed through an arthroscope. This approach has an advantage over open surgical synovectomy in that it avoids cutting and opening the joint capsule surgically. For this reason, recovery from arthroscopic synovectomy is generally quite rapid.Although it is more invasive, an open surgical synovectomy also has certain advantages. It provides the surgeon a better view of, and improved access into, the total joint, thereby facilitating thorough removal of the inflamed synovial tissue.On the horizon are other forms of synovectomy which may be available. One is a form of laser synovectomy which is presently being developed. Using the arthroscope, the surgeon vaporizes the inflamed synovium with the laser. Care must be taken not to injure ligaments or underlying cartilage.The second measure is radiation synovectomy. This form of therapy has been used extensively in Europe and in a few academic centers in the United States. The procedure consists of injecting a radioactive substance directly into the joint to eliminate synovitis. It has not been widely accepted in this country because of concerns about radioactive leakage from the joint. New forms of joint injection therapy are being developed, though, as researchers are trying to design a chemical that will react exclusively with rheumatoid synovium. This form of chemical synovectomy may be extremely effective if a chemical can be formulated to seek out and destroy only the destructive tissues while preserving the healthy and important ones.*112/209/5*

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