Synovectomy is an operation to remove the inflamed or diseased synovial lining of a joint. It is performed for conditions such as pigmented villonodular synovitis (PVNS), synovial chondromatosis, or inflammatory arthritis that has not responded to medical treatment.
The procedure may be performed arthroscopically (keyhole) or as an open operation, depending on the extent of disease and the joint involved. The diseased synovial tissue is identified and carefully removed using shavers, curettes, or surgical instruments. In PVNS, the goal is to remove as much abnormal tissue as possible. The operation takes one to three hours depending on the extent of disease.
Synovectomy is recommended for PVNS (a benign but locally aggressive condition causing recurrent bloody joint effusions), synovial chondromatosis (formation of cartilage nodules within the synovium), and occasionally for rheumatoid arthritis not responding to modern disease-modifying medications.
For PVNS: observation is sometimes appropriate for diffuse disease that is not causing significant symptoms. For rheumatoid arthritis: optimisation of disease-modifying medication is the primary treatment. Radiotherapy or radiosynovectomy (injection of a radioactive substance) may be used as adjuncts.
MRI to assess the extent of synovial disease. Blood tests. Standard pre-assessment.
Reduction of joint swelling, pain, and recurrent effusions. For PVNS, synovectomy reduces disease burden and may prevent joint damage, though recurrence is common with diffuse disease.
PVNS has a high recurrence rate (20–50% for diffuse disease) despite thorough synovectomy.
Common after extensive synovectomy. Aggressive physiotherapy is important.
Prolonged joint swelling.
Extensive synovectomy may risk nearby neurovascular structures.
Joint infection.
Bleeding into the joint after surgery.
Aggressive removal may damage cartilage.
General or regional anaesthesia.
Intensive physiotherapy begins immediately to prevent stiffness. Weight-bearing as tolerated. Recovery takes four to twelve weeks depending on the joint and extent of surgery. Long-term follow-up is essential, particularly for PVNS.
Regular follow-up with MRI to monitor for recurrence. For PVNS, follow-up for at least five years.
Pigmented villonodular synovitis is a benign but locally aggressive condition where the synovial lining grows abnormally, causing recurrent bloody joint swelling, pain, and eventually joint damage. It can be localised (nodular) or diffuse.
Localised PVNS has a low recurrence rate after complete excision. Diffuse PVNS has a high recurrence rate (up to 50%) and may require repeat surgery, radiotherapy, or emerging targeted medications.