Knee synovectomy in hemophilia.

Abstract

ABSTRACT: We sent questionnaires to 268 hemophilia clinics in the United States, asking about their experiences with knee synovectomy in hemophilic patients, and 86 clinics responded. Of those responding, 22 clinics reported a total of 65 synovectomies, one to seven cases per clinic, in patients ranging from 4 to 56 years of age. Follow-up periods ranged from six months to eight years. The indication for synovectomy was failure of medical management to control recurrent bleeding into the joint; preoperative frequency of bleeding ranged from 1 to 20 hemarthroses per month. Factor replacement for the surgery and postoperative period provided factor levels of 20 to 100%, for five days to three weeks. All but three surgeons routinely used a drain. Physical therapy was begun an average of ten days after surgery (median, 5 days) and consisted of isometric, active-assisted or active range-of-motion exercises. Some clinics used manipulation from 7 to 14 days after surgery; one manipulation was done three months after surgery with an improvement in range of motion. Most patients lost range of flexion postoperatively (from 10 to 50° lost). Four cases of postoperative ankylosis were reported. After synovectomy the frequency of hemarthrosis decreased in ail patients (0-1 /mo). We believe synovectomy can be useful for carefully selected patients in whom nonsurgical management has been ineffective, when done in centers with full laboratory and physical therapy support.