Synovectomy, with

Disease activity was suppressed in an uncontrolled study in seven patients with RA treated with penicillamine initial doses of 5OO mg/day were increased to 1.8 g/day. Side-effects eventually demanded cessation of treatment.131 At doses up to 1,5 g/day, penicillamine resulted in significantly lowered sertrni IgG and IgM but not IgA levels at 5 and 6 months in patients with RA, suggesting that at least part of its immunosuppressive effect is at the cellular level, and may be specific for cells which produce certain classes of immunoglobulins. 32 Radiation synovectomy with intra-articular injections of yttrium-90 in 1+h rheumatoid knee joints benefited 50 /o of the patients, however the long-term danger... 

Hydroxyapatite particles can be used for radiation synovectomy by exploiting the strong binding of rhenium diphosphonate complexes to the surface of hydroxyapatite (vide supra). The same 186Re-HEDP preparations as for bone palliative therapy are used. When injected into joints, these particles (mean diameter 25 pm, maximum diameter 45 pm) remain within the joint to the extent of at least 95% for several days in arthritic rabbits and rats [156], More recently, microspheres have been labeled with 188Re for this purpose [156a,b],... 

Radiation synovectomy involves therapy of rheumatic synovitis in knees inflicted with rheumatoid arthritis. Treatment involves the use of Dy-165 FMHA (270 mCi) or Ho-166 FMHA(lOmCi). 

Osmic acid is injected into joints for chemical synovectomy and is associated with local pain, effusions, and fever skin necrosis is less frequent (1). Nerve damage and abnormal urinary findings (hematuria, proteinuria, and leukocyturia) can occur (SEDA-12, 94). A potentially dangerous drug, it certainly should not be given to young patients. 

For a period of 1 to 3 days following osmarin injection the dogs exhibited evidence of increased discomfort in the treated joint. A similar period of increased discomfort was noted when normal rabbit joints were treated with osmarin, but was not seen in either normal or arthritic osmarin treated joints of pigs. The authors do not attirbute this short period of discomfort to the physical trauma of the injection. More likely explanations could be that osmarins cause a temporary decrease in synovial fluid viscosity, or that the discomfort is due to a type of chemical synovectomy which was previously noted in the rabbits. 

Vuorela J, Kauppinen T, Sokka T (2005) Distribution of radiation in synovectomy of the knee with Ho-FHMA using image fusion. Cancer Biother Radiopharm 20 333-337... 

Fig. 22.4 A case that required additional synovectomy because of the prolonged loss of extension after anatomic double-bundle ACL reconstruction with notchplasty. (a) MRI sagittal view) taken 3 months after surgery showed fibrosis of the infrapatellar fat pad (white arrow) adhered to the reconstructed ACL. (b) Arthroscopic view from the anterolateral portal. Fibrosis of the infrapatellar fat pad (yellow arrow) adhered to the reconstructed ACL...

The conclusions of this study are that, in anatomic double-bundle ACL reconstruction, anterior stability was improved and there were no harmful effects on patellofemoral joint findings by 2-mm notchplasty however, notchplasty likely caused over-constrained knees, leading to a need for additional synovectomy in some cases. On the other hand, anatomic double-bundle ACL reconstmction without notchplasty did not increase the incidence of loss of extension and graft failure. Therefore, except in cases with spur formation on the intercondylar notch or narrow notch, routine notchplasty is not recommended in anatomic double-bundle ACL reconstmction. 

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