Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Collaborative Specialization

Musculoskeletal Health Research

Supervisor

Bryant, Dianne

2nd Supervisor

Appleton, Tom

Co-Supervisor

3rd Supervisor

Lanting, Brent

Co-Supervisor

Abstract

Objective: This randomized controlled trial (RCT) aimed to examine the role of synovectomy during total knee arthroplasty (TKA) in pain reduction among patients with end-stage osteoarthritis who exhibited moderate to severe synovial inflammation, as determined by ultrasound assessment. Methods: Nine participants were randomized to undergo TKA surgery with or without synovectomy. Primary and secondary outcomes were assessed through a variety of patient-reported questionnaires that targeted pain, quality of life, joint function, and satisfaction, in addition to functional performance tests. Outcome data were collected pre-operatively, and at six weeks and 12-weeks post-operatively, and were compared between groups at all study time points. Results: Data analysis revealed no statistically significant differences between groups for all outcomes across all time points. Conclusions: It is too early to make any definitive conclusions regarding study results due to a small sample size and lack of adequate power. Participant recruitment and data collection remain ongoing.

Summary for Lay Audience

Osteoarthritis (OA) is the most common joint disease, with symptoms including joint pain and inflammation (synovitis). As a treatment option for advanced OA, a total knee arthroplasty (TKA) can be performed. TKA is a common and routinely successful operation that is performed to reduce pain symptoms, however, approximately 25% of patients are not satisfied with their outcome due to persistent pain post-surgery. Specifically, patients who suffer from more severe synovitis pre-surgery tend to have worse outcomes, especially joint pain, post-operatively. Previous research has suggested that the synovium could potentially be the source of persistent pain post-TKA. Therefore, a possible way to study this problem is to perform a synovectomy during TKA surgery, which involves removing the inflamed layer of tissue that lines the inside of the knee joint, called the synovium. Conducting this study will help to understand the effects of synovectomy and could identify whether the synovium is in fact the primary source that causes pain following TKA surgery. This study will include patients undergoing a TKA due to end-stage OA. To be eligible for study participation, patients must be diagnosed with moderate to severe synovitis, as determined by an ultrasound assessment of the operative knee. Patients will be randomly assigned to undergo a TKA with synovectomy or without synovectomy. To assess the study’s primary (knee pain) and secondary (quality of life, joint function, and satisfaction) outcomes, patients will complete self-reported questionnaires and functional performance tests. Outcome scores will be recorded before and after surgery to allow for comparison between study groups. Synovectomy is only a short-term solution for pain symptoms because the synovium will eventually grow back in the time following surgery. If study results demonstrate that synovectomy is effective at reducing pain post-TKA, this will help to provide evidence that the synovium should be targeted to reduce post-operative knee pain and could justify the development of other treatments that could slow the synovium’s regrowth to manage long-term pain symptoms.

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Available for download on Saturday, August 29, 2026

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