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In numerous puplications the results of synovectomy have been
written about where either one or another viewpoint have been
examined. In this publication, the attempt is made to collect as
many parameters as possible so as to get a most objective picture
of the therapeutic worth by studying 100 knee and 370 finger
synovectomies. During the survey, among other points, the following
important aspects were taken under consideration: The operative
results were not evaluated by the operating surgeon, but by a
rheumatologist who was not on the clinic staff. As is well known,
it is difficult to evaluate the X-ray picture objectively, since
very often "subjective impressions" prevail. Gschwend succeeded in
setting up - mainly for the synovectomized finger joints - a
comprehensive point system, so as not to leave the evaluation to
chance. Besides the purely local joint condition, an internal
rheumatological status, at the time of the operation and the
follow-up examinations, with corresponding laboratory tests, was
carried out and included in the evaluation. Finally, it should be
pointed out that this is a long term study of 5 years, with various
controls made in between. The examination of so-called control
groups, for the present study, seems to us to be highly problematic
and of little value for a statement. Essentially, only the local
condition with respect to pain and swellings im proves, while the
general activity of the inflammatory process as also the mobility
and deformity of the synovectomized joints will only be somewhat
influenced.
Early in its development, the subject matter of any field of
surgery is too ill-defined and opinions are too fluid for the
production of a book on the subject to be possible. Late in its
development, controversy is at an end, and although it is still
possible to produce a textbook, it is too late to produce a book
that might stimulate discussion and crystallise ideas. This book
has that objective, it being the Editor's view that the field of
the surgical treatment of arthritis of the knee had reached an
appropriate intermediate stage in 1978 when this text was written.
Three broad issues stand out as being in need of resolution before
the optimum form of surgical treatment for a given knee can be
defined more convincingly than is possible at present: Firstly:
What symptomatic and physical features of the knee are to be
recorded pre- and post-operatively, upon the basis of which
comparisons can be made between the results obtained by two
different surgeons or with two different tech niques. The
resolution of this issue requires general agreement not only upon
what features of the knee should be recorded but, crucially, upon
how these features should subsequently be presented so as to
characterise a particular group of knees.
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