With use of fluoroscopy, new techniques of percutaneous synovial biopsy (PSB) of large joints of limbs (other than the knee) were developed. PSB was performed on outpatients with the use of local anesthesia. Eighty-four biopsies (hip, 57; shoulder, 10; elbow, six; wrist, five; and ankle, six) were performed. With experience, modifications evolved in the PSB technique. The main technical refinements were use of a Tru-Cut needle introduced through a Jamshidi trephine needle, placement of the cutting window parallel to the anterior aspect of the joint, and selection of an optimal approach and biopsy site. With these improvements, the success rate for obtaining synovial membrane was raised from 48% to 81%. No complications were encountered.