Long-term results of elbow synovectomy and debridement in rheumatoid arthritis

Objective: to evaluate the efficiency of surgical treatment and the quality of life (QL) in patients with rheumatoid arthritis (RA) and elbow damage. Subjects and methods. Fifty-three patients who had undergone elbow synovectomy and debridement were examined 11±5.2 years postoper atively. Clinical and X-ray studies of the operated joint were conducted and its function and QL were assessed using the Mayo Elbow Score, Oxford Elbow Score, HAQ, and EQ-5D. Results. A control examination revealed the larger volume of elbow movements than that preoperatively. The preoperative and postoperative flexion of the elbow was 96.3±21.6 and 127.5±11.7° , respectively (p ≤ 0.05) and its extension was 37.1±8.7 and 17.3±6.9° , (p ≤ 0.05). According to the Mayo Elbow Score and Oxford Elbow Score, there was joint function improvement in the late periods. The mean Mayo index score preoperatively was 25.0±14.5 and the mean score postoperatively was 79.4±6.4. The mean preoperative and postoperative Oxford index scores were 13.8±4.8 and 32.2±8.6, respectively (p ≤ 0.05). The mean HAQ index score preoperatively was high (2.36±0.56). Postoperatively, there was substantial functional improvement in patients with a reduction in HAQ score to 1.67±0.22; the difference in the scores being 0.69 before and after treatment, which corresponded to the significant positive effect of therapy (at least 50% clinical improvement according to the American College of Rheumatology (ACR) criteria). The preoperative and postoperative EQ-5D scores were 019±0.028 and 0.53±0.07, respectively; the Δ EQ-5D score being equal to 0.34, which was indicative of a marked QL improvement in patients after surgical treatment (70% clinical improvement according to the ACR criteria). In the late postoperative period, pain in the affected elbow was reduced by almost twice: according to the visual analogue scale it was 73.8 and 40.6 mm preoperatively and postoperatively, respectively (p≤0.01). Analysis of some EQ-5D scales revealed that there was postoperative psychoemotional improvement; the patients had virtually no difficulty with self-care and day-to-day activity. Conclusion. Synovectomy with debridement and resection of the radial head causes pain relief, a larger volume of movements, improved function and QL in patients with RA in the late postoperative period.