Treatment Of Chronic Haemophilic Synovitis Research Articles

Chemical synovectomy vs. radioactive synovectomy for the treatment of chronic haemophilic synovitis: a prospective short-term study.

Between January 1992 and December 1994, a prospective study was performed in two centres comparing chemical synovectomy using repeated weekly injections (range, 1-17) of Rifampicin (Group R) vs. radioactive synovectomy using 1-2 injections of Yttrium-90 (Group Y). The study was performed on 38 joints in a total of 35 haemophilic patients suffering from chronic haemophilic synovitis unresponsive to 3 months of conservative treatment (substitution therapy with the deficient coagulation factor plus a rehabilitation protocol). Group R included 18 patients with an average age of 9 years, with an average follow-up time of 25 months. In Group R, 19 joints were treated: nine knees, four elbows and six ankles. Group Y included 17 patients with an average age of 18 years, with an average follow-up time of 23 months. In Group Y, 19 joints were treated: 14 knees, two elbows and three ankles. The joints were evaluated according to the frequency of bleeding episodes and the Pettersson radiographic score. On the basis of the radiographic scale at the time of the synoviortheses, the joints were categorized as stage I (0 points), stage II (1-2 points), stage III (3-7 points), stage IV (8-10 points) and stage V (11-13 points). The overall results showed that in Group R, bleeding decreased in 12 joints, remained the same in six and worsened in one. In Group Y, bleeding decreased in 11 joints, remained the same in seven and worsened in one. In both Groups, bleeding was controlled best if joints were in stages I and II. In stages III, IV and V, synoviorthesis should not be carried out in haemophilia because it is not effective. Use of radioactive substances in persons under the age of 9 years has been discouraged in the past and therefore only Rifampicin was used in this age group. However, in patients over 9 years of age, this study showed similar decrease of bleeding in both treatment groups. Taking into account the advantages and disadvantages of both agents, we suggest the use of Rifampicin in elbows and ankles but prefer Yttrium-90 for the knees.

Arthroscopic synovectomy in the treatment of hemophilic synovitis.

Chronic proliferative synovitis is a frequent complication of hemophilia for which effective treatments are lacking. Over a three year period we employed arthroscopic surgery on 7 knees in 6 patients with hemophilic synovitis refractory to standard treatment including anti‐inflammatory drugs, prophylactic factor infusion and physical therapy. Operative findings included diffuse villous synovial proliferation covering most cartilagenous surfaces of joint spaces in all six cases, varying degrees of articular erosion, osteochondral defects, and various forms of meniscal tear. One patient with an advanced degree of arthropathy had an extensive scar and interarticular fibrous band adhesions. Peri‐operatively morbidity was minimal, permitting early institution of physical therapy. Joint effusion resolved within one month of surgery. During the 6 month to 3 year post‐operative follow‐up, bleeding frequency was markedly reduced in all cases. In contradistinction to open surgical synovectomy, which encountered an unacceptably high incidence of post‐operative reduction in joint mobility, the range of knee joint motion after arthroscopic synovectomy was well preserved or improved in 4 of 6 patients. Two patients have lost the range of knee joint motion in post‐arthroscopic follow‐up; one patient sustained a tibial fracture requiring a long leg cast on the same knee, and the other had severe arthropathy with a reduced range of motion prior to arthroscopy. All patients have experienced pain relief and improved knee function. We conclude that arthroscopic synovectomy is a promising treatment of chronic hemophilic synovitis of the knee with low surgical morbidity and with long‐term benefit comparable to or better than that reported with open synovectomy.