Arthroscopic synovectomy: state of the art

Abstract

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.

Guidelines for the management of hemophilia

“…Surgical procedures, depending on the specific condition needing correction, may include: extra-articular soft tissue release to treat contractures. arthroscopy to release intra-articular adhesions and correct impingement. [] osteotomy to correct angular deformity. prosthetic joint replacement for severe disease involving a major joint (knee, hip, shoulder, elbow). [] elbow synovectomy with radial head excision.…”

Modern management of haemophilic arthropathy

“…Although this approach may be effective in decreasing subsequent haemarthroses, its main complication is the loss of motion that occurs after the procedure (Wiedel, 2002). This loss of motion, along with the relative invasiveness of the procedure, makes open synovectomy a rather undesirable approach given the alternatives discussed below.…”

“…Arthroscopic synovectomy has been used most frequently in the knees, but there is increasing experience in the ankles, elbows and shoulders (Patti & Mayo, 1996;Wiedel, 2002;Dunn et al, 2004). Figure 3 shows an arthroscopic view of the inflamed synovium in a patient with haemophilia.…”

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

“…Včasih je po dogovoru z ortopedom, ki ima izkušnje z zdravljenjem zapletov na kosteh in sklepih pri osebah s hemofilijo, potrebna rekonstruktivna kirurgija. Vključuje vstavitev umetnih sklepov (endoproteza), da se izboljšajo funkcijske sposobnosti ali pa se reši vprašanje zelo močnih bolečin v enem sklepu (162)(163)(164)(165)(166). Ustrezno kratkotrajno ali daljše terciarno profilaktič-no zdravljenje te postopke omogoča in preprečuje slabšanje stanja.…”