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

Abstract

The aim of the present study was to assess the clinical outcomes of arthroscopic synovectomy in adolescent or young adult patients with advanced haemophilic arthropathy. From January 2009-January 2012, clinical data from 11 adolescent or young adult patients with advanced haemophilic arthropathy who were treated with arthroscopic synovectomy were retrospectively collected. The mean follow-up period was 71.91±5.28 months. The evaluated indicators included frequency of joint bleeding, range of motion (ROM), X-ray staging, hospital for special surgery (HSS) knee score and HSS pain scores. Joint bleeding frequency, pain degree and HSS scores significantly improved following arthroscopic synovectomy at the end of the follow up period. The ROM did not significantly improve. Among the 11 patients, radiographic stage remained unchanged in 9 cases whereas the remaining 2 cases progressed from stage IV to stage V. No patients required total knee arthroplasty through the end of the follow-up period. These findings suggested that arthroscopic synovectomy appears to an effective treatment option to decrease the frequency of bleeding and knee pain, improve knee function and delay knee joint arthroplasty to a certain extent for adolescent or young adult patients with advanced haemophilic knee arthropathy.

Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres

“…Arthroscopic synovectomy is indicated, when other less invasive procedures failed, to delay arthropathy progression, to reduce the frequency of joint bleedings and the need of replacement therapy. Although an open procedure is feasible, the vast majority of authors prefer the arthroscopic technique, as less invasive, applicable to nearly all joints 80 , 85 , 86 in combination with an additional procedure such as removal of tibial anterior osteophytes in ankles. 76 …”

“…Statement 37: Arthroscopic synovectomy is the first-choice treatment after failure of non-surgical synovectomy (NO agreement/disagreement) Arthroscopic synovectomy is indicated, when other less invasive procedures failed, to delay arthropathy progression, to reduce the frequency of joint bleedings and the need of replacement therapy. Although an open procedure is feasible, the vast majority of authors prefer the arthroscopic technique, as less invasive, applicable to nearly all joints 80,85,86 in combination with an additional procedure such as removal of tibial anterior osteophytes in ankles. 76 The procedure must be performed by an experienced team at a dedicated haemophilia treatment centre with a long period of prophylaxis coverage sufficient for the procedure and postoperative rehabilitation.…”

Pain management in hemophilia: expert recommendations

“…In a study on young patients, arthroscopic synovectomy led to a reduction of joint bleeds and pain and improved joint function. This significant improvement was still visible 6 years later [ 108 ]. The procedure did not influence the osteoarthritis stage, but endoprosthetic care could be delayed, which is a relevant aspect especially in young patients.…”