Surgical synovectomy for haemophilic arthropathy of the knee joint. Long-term follow-up

Arthroscopic synovectomy for hemophilic joint disease in a pediatric population

Children with hemophilia can develop progressive arthropathy. Arthroscopic synovectomy has been used to reduce hemarthroses, but few long-term results have been published. In this article the authors review their first 12 years of experience. Data are reported on 44 pediatric patients (69 joints: 39 ankles, 21 elbows, 7 knees, 2 shoulders). The median age at surgery was 10 years Median follow-up was 79 months. Joints with sufficient follow-up data showed a median bleeding frequency decline of 84% (P < 0.001). Median arc of motion was stable or improved in the year after surgery in ankles, elbows, and shoulders. Complications were rare. Radiographic scores worsened slightly. In this largest analysis of arthroscopic synovectomy for children with hemophilia, rehabilitation was not problematic.

Arthroscopic synovectomy for hemophilic joint disease in a pediatric population

Children with hemophilia can develop progressive arthropathy. Arthroscopic synovectomy has been used to reduce hemarthroses, but few long-term results have been published. In this article the authors review their first 12 years of experience. Data are reported on 44 pediatric patients (69 joints: 39 ankles, 21 elbows, 7 knees, 2 shoulders). The median age at surgery was 10 years Median follow-up was 79 months. Joints with sufficient follow-up data showed a median bleeding frequency decline of 84% (P < 0.001). Median arc of motion was stable or improved in the year after surgery in ankles, elbows, and shoulders. Complications were rare. Radiographic scores worsened slightly. In this largest analysis of arthroscopic synovectomy for children with hemophilia, rehabilitation was not problematic.

Arthroscopic synovectomy: state of the art

Arthroscopic synovectomy for first performed for haemophilic arthropathy in 1980 and was considered a major improvement over open surgical synovectomy, causing less postoperative morbidity and fewer hospitalizations, and preserving range of motion. Long-term results have shown that recurrent haemarthroses are decreased and joint function is preserved. Radiographic changes, however, suggest continued progression of the disease process. The procedure is technically demanding and requires considerable resources including skilled personnel, surgical equipment and an adequate supply of factor concentrate, all of which limit the availability of the procedure worldwide. Where this procedure fits into the treatment of chronic haemophilic synovitis depends very much on location and availability of resources. Consequently, the procedure should not be considered as the first-line approach for recurrent haemarthroses, but rather as a secondary procedure if alternative measures have failed.

Expanding portal haematomata as a complication of knee arthroscopies in persons with haemophilia

Recurrent haemarthroses stimulate the hypertrophy of synovial tissues that if left in situ will eventually cause joint destruction. Synovectomies have been the cornerstone of joint preservation and a number of different methods exist. We report two patients who suffered complications after an arthroscopic procedure. No previous complications of this nature have been reported in the literature.

Arthroscopic synovectomy of the knee in hemophilia: 10-to-15 year followup

Nine knees in 8 patients with severe hemophilia A and 1 patient with hemophilia B underwent arthroscopic synovectomy during the period of 1980 to 1985. This group of patients has been observed prospectively for the past 10 to 15 years. One complication occurred immediately postoperatively in an 8-year-old boy in whom a severe hemarthrosis developed that required arthroscopic evacuation. His postoperative recovery was compromised leading to significant loss of motion. Recurrent hemarthroses developed in only 1 patient after an injury to the knee. A second arthroscopic synovectomy was performed 45 months after the initial procedure. Other than the patient who lost motion after the postoperative complication, all patients initially regained or improved their range of motion. The latest followup, however, showed several patients losing motion which correlated with clinical and radiographic evidence of progressive changes of the hemophilic arthropathy. The 1 patient with Factor IX deficiency required a total knee replacement 8 years after synovectomy. Arthroscopic synovectomy was effective in reducing recurrent hemarthrosis and maintaining range of motion; however, joint deterioration continued to occur although probably at a slower rate.