Treatment of inflammatory arthritis by synovial ablation: a comparison of the holmium: YAG laser, electrocautery, and mechanical ablation in a rabbit model

Abstract

Background and objective: Although the majority of patients with immune-mediated inflammatory arthritis are managed conservatively, some patients may require synovectomy if they have persistent pain secondary to chronic unresponsive swelling of a joint. In this study, three methods of synovial ablation using laser energy, electrocautery, and mechanical debridement were compared in an in vivo chronic synovitis rabbit model. STUDY DESIGN/MATERIALS, AND METHODS: In the first phase of this study, the optimal laser energy/pulse frequency combination for synovial ablation in this model was determined. In the study's second phase, 48 mature rabbits were then divided into four equal groups: laser synovectomy, electrocautery synovectomy, mechanical synovectomy, and control. Chronic synovitis was induced in both stifles of all treatment groups and in the right stifle of the control rabbits. Synovectomy was performed on one stifle of each rabbit; the contralateral stifle served as a sham-operated control. Six rabbits per group were euthanized 2 weeks and 3 months after surgery, respectively.

Results: There were no differences among groups in synovial fluid parameters, except at 2 weeks, when the electrocautery group had significantly more white blood cells than the laser and mechanical debridement groups. Histologic examination revealed that mechanical debridement resulted in significantly more synovial hemorrhage, capillary dilatation, plasma cell infiltration, lymphocyte infiltration, joint capsular defects, and poorer synovial ablation than ablation achieved with either laser energy or electrocautery.

Conclusion: Laser energy and electrocautery achieved similar results when used for ablative purposes, although electrocautery did not achieve the same degree of synovial ablation as laser energy.