[Synovectomy in the treatment of acute arthritis caused by Micrococcus pyogenes].

In addition to antibiotic therapy associated with immobilization in a plaster cast, effective in the majority of cases of acute arthritis caused by St. pyogenes and resection-arthrodesis which is necessary in the stage of osteoarthritis, synovectomy occupies an intermediate position. During a period--possibly not a short one--when the lesions are still purely synovial and do not regress under medical treatment, their ablation permits recovery from the infection with restoration of the functional activity of the joint. The experience is based on 26 observations (19 knees, 3 hips, 2 shoulders, 1 thumb, 1 metacarpo-phalangeal lesion). In 2/3 of cases these arthritides were iatrogenic (13 after cortisone infiltration, 4 postoperative, 1 haematogenic from i.v. catheterization). Synovectomy should be complete; haemostasis must be rigorous; an aspiration drain is left in place for 5 or 6 days; additional immobilization in plaster is not obligatory; antibiotic treatment is continued until the BSR has returned to normal. As regards control of the infection, this was obtained in 19 of 26 operations. As regards function, in 10 of these cases the results were very good, in 7 good (slight persistent restriction of movement), in only 2 cases the results were unsatisfactory. The factors that appear to affect the results are on the one hand rigorous technique and on the other sufficiently early operation before the lesions have become too fully established. However, a study of arthritides after cortisone infiltration of previously affected joints has shown that even relatively late operation can lead to satisfactory results (9 of 13).