SYNOVECTOMY FOR HEMOPHILIC ARTHROPATHY - 6-21 YEARS OF FOLLOW-UP IN 16 PATIENTS

Objectives. To assess the efficacy of synovectomy in reducing recurren t haemarthroses and joint pain in patients suffering from haemophilic arthropathy. Moreover, to study whether synovectomy could improve join t mobility or postpone progression of joint destruction. Design. A ret rospective study was conducted addressing joint-related symptoms and f indings, and the need of orthopaedic surgery during follow-up. Setting . Oslo Sanitetsforenings Rheumatism Hospital/The National Hospital, th e National Centre for Orthopaedic Surgery for approximately 180 Norweg ians suffering from severe congenital coagulation deficiencies. Subjec ts. Twelve patients with haemophilia A, two patients with von Willebra nd's disease and two patients with factor VII deficiency in which 21 s ynovectomies (nine knees, six ankles and six elbows) were performed. M ain outcome measures. Joint pain, joint mobility, frequency of haemart hroses and radiographic joint scores at follow-up were compared to pre operative figures, and the number of joints in need of total joint rep lacement or arthrodesis was evaluated. Results. Synovectomy proved eff icacious in reducing recurrent haemarthroses and joint pain in all pat ients. The total range of motion was not improved, but correction of e xtension deficiency of the knee was accomplished. The progression of a rthropathy was not arrested by synovectomy as judged by the radiograph ic assessment; and in four patients arthroplasty of the knee, and in t wo patients arthrodesis of the ankle, had been performed. A major woun d haemorrhage and subsequent wound rupture was seen in one patient who developed high-titred neutralizing antibodies to factor VIII. Conclus ions. Synovectomy for haemophilic arthropathy is safe and efficacious in reducing recurrent haemarthroses and joint pain. Synovectomy should not be performed to improve joint mobility. The progression of the ar thropathy is not arrested, and subsequently many patients will be cand idates for arthroplasty or arthrodesis.