Arthroscopic synovectomy in haemophilic arthropathy of the knee

Abstract

From January 1996 to January 2001, arthroscopic synovectomies were performed in 28 knees with haemophilic arthropathy. The mean follow-up period was 5 years and 11 months. Six portals (two anterior, two suprapatellar, two posterior) and a posterior trans-septal portal were used in all cases. The average Hospital for Special Surgery (HSS) knee score increased from 56.4 to 71.5 points at the last follow-up. The average frequency of haemarthrosis reduced from five times per month before operation to once per month. The amount of factor replacement decreased from a mean of 4,633 U to 1,505 U. Progression of arthritis was observed radiographically in three cases at the last follow-up. An arthroscopic synovectomy of the knee using appropriate arthroscopic portals is a useful method in treating haemophilic patients as it decreases bleeding episodes, amount of factor replacement and knee pain.Résumé De janvier 1996 à janvier 2001, des synovectomies arthroscopiques ont été exécutées dans 28 genoux avec une arthropathie hémophilique. Le suivi moyen était 5 années et 11 mois. Six abords (deux antérieurs, deux suprarotuliens, deux postérieurs) et un abord trans-septal postér-ieur ont été utilisé dans tous les cas. Le score moyen du genou de l'Hôpital pour Chirurgie Spéciale (HSS) a augmenté de 56,4 à 71,5 points au dernier examen. La fré-quence moyenne d'hémarthrose s'est réduite de cinq fois par mois avant l'opération à une fois par mois aprés. La quantité moyenne de remplacement de facteur a diminué de 4,633 à 1,505 unités. Dans l'évaluation radiographique, la progression de l'arthrite a été observée dans trois cas au dernier suivi. Une synovectomie arthroscopique du genou qui utilise des abords arthroscopiques appropriés est une méthode utile pour traiter les malades hémophiliques, diminuant les épisodes de saignement, la quantité de facteur et les douleurs du genou.

Survival analysis of Y‐90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10‐year retrospective review

“…Wiedel also reported a 10-15 year-followup of nine arthroscopic synovectomies of knees that, though successful in controlling recurrent haemarthroses and probably slowing progression, arthroscopic synovectomy did not halt the development of haemophilic arthropathy [25]. This is in agreement with the observations of Dunn et al and Yoon KH et al [26,27]. However, radionuclide and arthroscopic synovectomy have never been compared in a prospective randomized trial.…”

Guidelines for the management of hemophilia

“…Options for synovectomy include chemical or radioisotopic synoviorthesis, and arthroscopic or open surgical synovectomy. (Level 4) [] Non-surgical synovectomy is the procedure of choice. Radioisotopic synovectomy using a pure beta emitter (phosphorus-32 or yttrium-90) is highly effective, has few side effects, and can be accomplished in an outpatient setting. (Level 4) [ ] A single dose of clotting factor is often sufficient for a single injection of the isotope. Rehabilitation is less intense than after surgical synovectomy, but is still required to help the patient regain strength, proprioception, and normal functional use of the joint. If a radioisotope is not available, chemical synoviorthesis with either rifampicin or oxytetracycline chlorhydrate is an appropriate alternative [].…”

Clinical outcomes of arthroscopic synovectomy for adolescent or young adult patients with advanced haemophilic arthropathy

“…A number of studies regarding arthroscopic synovectomy for haemophilic arthropathy have also included some cases of stage IV arthropathy. Yoon et al reported 28 cases of arthroscopic synovectomy for haemophilic knee joints ( 24 ). Of these cases, the staging of six knee joints was stage IV; however, the clinical results for the stage IV arthropathy were not listed separately.…”