SYNOVECTOMY IN HEMOPHILIAC HEMARTHROSIS

Abstract

Joint bleeding in hemophiliacs initiates a cycle of synovial lesions and repeated hemarthrosis. Disabling hemophiliac arthropathy may be the end result despite adequate plasma component therapy. Synovectomy which has been made feasible by improvements in component therapy may be used to interrupt this vicious cycle in selected cases. Indications for synovectomy include frequent and chronic recurrent hemarthroses not responding to medical management and a cooperative family. Fifteen synovectomies have been performed in 9 patients with hemophilia A. The average age was 12 years. The procedure was performed on 4 knee joints, 4 ankle joints and 7 elbow joints. There were no instances of early or late hemorrhage. The hospital time averaged 11 days. Re-bleeding into the joint has been absent or markedly decreased in an average 3 year period. There was some improvement in joint range of motion in 50% of patients and radiologic improvement was also noted. In selected hemophilia patients, synovectomy may be indicated as a hemostatic procedure.