OPEN SYNOVECTOMY FOR THE PREVENTION OF RECURRENT HEMARTHROSIS OF THE ANKLE IN PATIENTS WITH HEMOPHILIA - A REPORT OF 5 CASES WITH MAGNETIC-RESONANCE-IMAGING DOCUMENTATION

Hemophilic arthropathy is an incapacitating complication of severe hem ophilia resulting from recurrent bleeding in the same joint. Open syno vectomy has been used since 1969 to prevent recurrent hemarthrosis of target joints. Between 1988 and 1993 we performed open synovectomy of the ankle in five hemophiliacs aged 6 to 9 years with early-stage hemo philic arthropathy. Magnetic resonance imaging proved very useful for evaluating the severity of joint damage, usually underestimated on pla in radiographs; for determining the degree of synovial membrane hypert rophy, which is a critical factor in the decision to perform synovecto my; for planning the surgical procedure and for explaining treatment f ailures. A decrease in the frequency of hemarthrosis episodes occurred in all five ankles, A repeat synovectomy was needed in one case and i n another patient the frequency of hemarthrosis episodes increased som ewhat after the fourth year. There was no loss of range of motion. Our data suggest that open synovectomy is effective and safe for reducing the frequency of hemarthrosis and that magnetic resonance imaging sho uld be routinely performed before the procedure.