Synovectomy for Osteoarthritis

This trial aims to determine if removing the inflamed joint lining during knee replacement surgery can reduce pain for individuals with severe knee arthritis. Participants will undergo knee replacement either with or without this additional step, known as synovectomy, to assess its impact on pain and quality of life. The trial seeks individuals over 40 with severe knee arthritis and inflammation who are planning their first knee replacement surgery. As an unphased trial, it provides a unique opportunity to contribute to medical knowledge and potentially enhance future treatment options.

The trial does not specify if you need to stop taking your current medications, but if you are using disease-modifying anti-rheumatic drugs (like methotrexate or TNF inhibitors), you cannot participate. Also, you should not have had a joint injection within 12 weeks before your clinic appointment.

Research has shown that synovectomy, the removal of inflamed tissue from a joint, is generally safe during knee replacement surgery. Studies have found that although synovectomy may lead to more blood loss and longer surgery time, it does not increase the risk of complications or the need for blood transfusions. Additionally, there is no added risk of pain or reduced function after surgery compared to having a knee replacement alone. For those considering joining a trial, past patients have tolerated the procedure well.¹²³⁴⁵

Researchers are excited about synovectomy as a treatment for osteoarthritis because it offers a potential enhancement to traditional total knee replacement surgeries. Unlike standard treatments that focus solely on replacing the joint, this approach involves partially removing inflamed synovial tissue during the procedure. This could help reduce inflammation and improve joint function, leading to better long-term outcomes for patients. By addressing both the joint structure and the inflammation source, synovectomy may offer a more comprehensive solution to knee osteoarthritis.

This trial will compare total knee replacement with and without partial synovectomy. Research has shown that removing inflamed tissue during knee replacement surgery, known as synovectomy, doesn't significantly improve pain relief or overall satisfaction. Studies have found that it might lead to more blood loss and longer surgery times without providing lasting benefits for pain or knee movement. Specifically, knees that underwent this procedure showed less flexibility and worse pain scores. Current evidence suggests that synovectomy doesn't improve long-term outcomes for osteoarthritis patients undergoing knee replacement surgery. While it temporarily removes inflamed tissue, it doesn't seem to offer clear long-term benefits.¹²⁶⁷⁸