Surgical synovectomy of the knee in young haemophiliacs: Long-term results of a monocentric series of 23 patients

Abstract

Background In haemophiliacs, synovectomy is indicated for recurrent joint bleedings, despite medical treatment. Method We report a series of 23 surgical synovectomies of the knee with a median follow-up of 8.8 years. The median age of patients at surgery was 13.5 years. Clinical and radiological evaluations were made according to the Petrini and the Pettersson scores, at 1 and 5 years after surgery, and at the last follow-up. Wilcoxon and Spearman's tests were used for the statistical analysis. Result The Petrini score improved at 1 and 5 years (P \ 0.001). Nine patients have 20 years of follow-up and a stable result. In more than half of the knees, no episode of recurrent bleeding occurred. The effect of surgery on the range of motion (ROM) was moderate and mobilisation under anaesthesia did not improve it significantly. There was a progressive worsening of the radiological score, but no correlation between clinical and radiological score was noticed (q = 0.08, P = 0.77). Conclusion Complete synovectomy gives good long-term results in term of bleeding recurrence and overall function.

Measurement of joint health in persons with haemophilia: A systematic review of the measurement properties of haemophilia‐specific instruments

“…As we do not expect that several years of regular prophylaxis in children with a mean score of 2.0 ± 3.6 would substantially decrease the score, responsiveness cannot be reliably assessed . However, in a population of children and adults, there was a clear improvement in PJS score after surgical synovectomy …”

“…For hypotheses testing, four studies (three including children and one including adults) were assessed as having “fair” methodological quality . In a follow‐up study, a subset of patients were re‐evaluated after changes in prophylactic treatment and therefore were excluded in this systematic review to avoid duplicate inclusion of patients .…”

“…For hypotheses testing, four studies (three including children and one including adults) were assessed as having "fair" methodological quality. 18,[35][36][37] In a follow-up study, a subset of patients were re-evaluated after changes in prophylactic treatment and therefore were excluded in this systematic review to avoid duplicate inclusion of patients. 36,37 Satisfactory correlation was found with the Pettersson score; however, the correlation with MRI was borderline at 0.48, with a predefined threshold of 0.50 for a good correlation.…”

“…In a study with a mixed adult and paediatric population, there was no correlation with the Pettersson score in patients awaiting surgical synovectomy. 35 Therefore, in children, moderate evidence for good hypotheses testing properties were found and for the overall population evidence was conflicting.…”

“…37 However, in a population of children and adults, there was a clear improvement in PJS score after surgical synovectomy. 35 None of the studies addressed internal consistency, reliability, measurement error or structural validity.…”