Sarah Lewis, PharmD
What is a synovial biopsy?
A synovial biopsy is a minimally invasive procedure that helps diagnose joint problems. This includes inflammatory conditions, infections, arthritis, cancer, and autoimmune disorders. Your doctor uses either a needle or an arthroscope to remove a sample of joint tissue. An arthroscope has a tiny camera that allows your doctor to view the inside of a joint. Your doctor will send the joint tissue sample to a lab for testing.
Synovial biopsy is a minor procedure, but it involves some risk and potential complications. You may have less invasive diagnostic options. Consider getting a second opinion about all of your diagnostic options before having a synovial biopsy.
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Why is a synovial biopsy performed?
Your doctor may recommend a synovial biopsy to help diagnose joint problems when a cause is not clear. A synovial biopsy is not a routine diagnostic procedure. Your doctor will only consider a synovial biopsy when other methods cannot find the cause of joint problems. Ask your doctor about all of your testing options before deciding on a synovial biopsy.
Your doctor may recommend synovial biopsy to diagnose the following conditions:
Arthritis, including osteoarthritis and gout
Autoimmune disorders, including rheumatoid arthritis and lupus
Cancer, including synovial cancer and leukemic arthritis
Joint infections, also called septic arthritis
Metabolic diseases, including hemochromatosis, which leads to abnormal iron deposits
Who performs a synovial biopsy?
Orthopedic surgeons and rheumatologists perform synovial biopsies. Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments. Rheumatologists specialize in diagnosing and treating arthritis and other rheumatic diseases. Rheumatic diseases affect your joints, tendons, ligaments, bones and muscles.
How is a synovial biopsy performed?
Your synovial biopsy will be performed in a hospital or outpatient setting. It involves inserting either a needle or an arthroscope into your joint and removing a sample of tissue.
A needle biopsy involves inserting a needle into the joint to take the tissue sample. Your doctor may use ultrasound to help guide the needle placement.
Arthroscopy involves making at least two small incisions in the joint. Your doctor will insert an arthroscope and special instruments through the incisions. A tiny camera on the arthroscope allows your doctor to view the inside of your joint on a video screen. This helps your doctor to take a tissue sample from a very precise location in your joint.
Types of anesthesia
Your doctor will perform your synovial biopsy using general anesthesia, regional anesthesia, or local anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain.
Local anesthesia involves injecting the anesthetic in the skin and tissues around the procedure area. You will likely have sedation with local anesthesia to keep you relaxed and comfortable.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of your body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your synovial biopsy
The day of your biopsy, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the procedure consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The procedure team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The procedure team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a synovial biopsy?
Problems with a synovial biopsy are not common, but any procedure has risks and potential complications. Complications can become serious and life threatening in some cases. Complications can develop during the procedure or your recovery.
General risks of surgery
Although rare for a synovial biopsy, the general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of a synovial biopsy
Complications of a synovial biopsy include:
Accidentally entering the wrong joint
Bleeding into the joint
Blood vessel damage
Instrument breakage during surgery
Joint stiffness or damage
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Alerting all members of the care team which joint is being biopsied
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as severe swelling, bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my synovial biopsy?
You are an important member of your own healthcare team. The steps you take before a synovial biopsy can improve your comfort and outcome. You can prepare for a synovial biopsy by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home after the biopsy. It is also a good idea to have someone stay with you for the first 24 hours.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include X-rays, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing a biopsy can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a synovial biopsy? Are there any other options for diagnosing my condition?
What type of procedure do I need?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
Will I need physical therapy? Where do I go for it?
What kind of assistance will I need at home?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my synovial biopsy?
Knowing what to expect after a synovial biopsy can help make your road to recovery as smooth as possible.
How long will it take to recover?
You will likely go home the same day of your synovial biopsy. Your comfort and recovery after the procedure will depend on whether your doctor uses a needle or an arthroscope. Recovery after a needle biopsy is generally shorter than after an arthroscopic biopsy. Ask your doctor what to expect after your particular procedure.
You will need to protect the joint and keep the area clean and dry as directed. Many people can return to moderate daily activities, such as work or school, within a few days. You doctor will tell you when it is safe to return to all your normal activities, sports, and exercise programs. Full recovery takes several days to weeks depending on your joint condition.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your procedure. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a synovial biopsy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might a synovial biopsy affect my everyday life?
Most people return to their usual activities after a synovial biopsy. If the results are not normal, your doctor will guide you through the steps necessary to manage your joint condition. This may involve medical or surgical treatment.
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