Influence of synovectomy on blood loss and need for transfusion in standard total knee replacement

Ausó-Pérez, José Ramón; Rodríguez-Blanes, Gloria María

doi:10.1007/s00590-018-2160-8

Cited by 4 publications

(12 citation statements)

References 24 publications

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“…We concluded that blood loss via drainage and pre- and postoperative hemoglobin difference was greater in the synovectomy group. Many studies agree with our findings in term of blood loss [6, 13]. An accurate synovectomy technique is vital to prevent blood loss.…”

Section: Discussionsupporting

confidence: 90%

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Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2019

J Orthop Surg Res

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Background During primary total knee arthroplasty (TKA), synovectomy as a part of the procedure has been recommended to relieve pain and inflammation of the synovium, but there is a controversy about it due to increased bleeding. In this meta-analysis, the aim is to answer whether synovectomy should be performed routinely during TKA for symptomatic knee osteoarthritis (KOA). Methods Relevant randomized controlled trials (RCTs) on synovectomy were retrieved through database searches of PubMed, Embase, Web of Science, and Cochrane Library up to February 2019. Studies that compared postoperative pain, clinical Knee Society Score (KSS), functional KSS, range of motion (ROM), drainage, pre- and postoperative hemoglobin difference, transfusion rate, operative time, and/or complications were included in the meta-analysis. Review Manager 5.3.0 was used for meta-analysis. Results We included 5 RCTs with 542 knees. Pooled results indicated that the synovectomy group was associated with more blood loss via drainage (WMD = − 99.41, 95% CI − 153.75 to − 45.08, P = 0.0003) and pre- and postoperative hemoglobin difference (WMD = − 0.93, 95% CI − 1.33 to − 0.5, P < 0.00001), compared with the non-synovectomy group. No statistically significant differences were demonstrated between both groups in postoperative pain, clinical KSS, functional KSS, ROM, transfusion rate, or complications ( P > 0.05). Conclusions The current evidence demonstrates that performing synovectomy in primary TKA for symptomatic KOA does not have any clinical benefit. It increases postsurgical blood loss. Surgeons routinely undertaking synovectomy should deliberate whether this is clinically indicated and consider limiting resection, if possible.

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Section: Discussionsupporting

confidence: 90%

“…Synovectomy is performed during primary total knee arthroplasty (TKA) for KOA mainly in the light of a surgeon’s experience and preference [6]. Orthopedic surgeons administering synovectomy claim that synovitis is the main cause of knee joint swelling and pain [7].…”

Section: Introductionmentioning

confidence: 99%

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2019

J Orthop Surg Res

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“…Many factors, such as surgical technique, tourniquet application, and thromboprophylaxis agents, may all be responsible for variability in intraoperative and postoperative blood loss. Several previous studies evaluated the effect of synovectomy on bleeding during TKA, and demonstrated that the synovectomy group resulted in more blood loss with or without higher hemarthrosis rates [6–8,12] …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, several clinical trials have been performed to evaluate the pain, function, and inflammation related to synovectomy in patients with knee OA at short-term follow-up. [5][6][7][8]12] A meta-analysis based on the previous clinical trials has demonstrated that conducting synovectomy in primary TKA for patients with OA does not relieve pain during 1year follow-up period. [14,22] It was demonstrated in our study that excision or retention of synovium has little effect on postoperative pain post-TKA during a 10-year follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…One may believe that retaining the synovium during TKA may deteriorate the knee function and will not improve inflammatory conditions and relieving pain. Therefore, several clinical trials have been performed to evaluate the pain, function, and inflammation related to synovectomy in patients with knee OA at short-term follow-up [5–8,12] . A meta-analysis based on the previous clinical trials has demonstrated that conducting synovectomy in primary TKA for patients with OA does not relieve pain during 1-year follow-up period [14,22] .…”

Section: Discussionmentioning

confidence: 99%

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Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial

Zeng

Wang

et al. 2023

Chinese Medical Journal

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Background: Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up. Methods: This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery. Results: At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84°vs. 114.02 ± 9.43°, t = 0.221, P = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U = 789.500, P = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively (P > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups (P > 0.05). Conclusions: Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely. Trial registration: Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj= 13334.

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Should synovectomy be performed during total knee arthroplasty for knee osteoarthritis

Shi

Yin

et al. 2021

Medicine

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Background: To evaluate the effect of synovectomy performed during primary total knee arthroplasty for knee osteoarthritis on patients' postoperative pain and knee function.Methods: We will search the following electronic databases from inception to June 2021, including PubMed, EMBASE, Web of Science, the Cochrane Library, the China National Knowledge Infrastructure, the Chinese Scientific Journals Database, the Wanfang database, and the Chinese Biomedicine Database. Eligible references will be all randomized controlled trials of initial total knee arthroplasty for primary knee osteoarthritis with or without synovectomy. Two reviewers will independently extract the data. Reviewer Manager 5.3 software will be used for statistical analysis.Result: It will provide results on the short-and long-term efficacy and safety of synovectomy in total knee arthroplasty by various comprehensive assessments.Conclusion: This study will provide solid evidence on whether and when synovectomy treatment should be performed during total knee arthroplasty.

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Influence of synovectomy on blood loss and need for transfusion in standard total knee replacement

Cited by 4 publications

References 24 publications

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial

Should synovectomy be performed during total knee arthroplasty for knee osteoarthritis

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