Arthroscopic synovectomy in children and adolescents with hemophilia

Purpose: To retrospectively review the authors' institutional experience with arthroscopic synovectomy in young patients with hemophilia. Patients and Methods: Patients with moderate or severe hemophilia seen in the authors' center were eligible to undergo synovectomy if they developed subacute or chronic synovitis that did not improve with prophylactic factor replacement. A single orthopedic surgeon performed all procedures. Each patient received aggressive physical rehabilitation and regular factor replacement for 6 weeks following surgery. Outcome data regarding the frequency of bleeding and range of motion were evaluated. Results: Twenty-eight arthroscopic synovectomies (11 knees, 12 ankles, 5 elbows) were performed on 26 joints in 20 hemophilia patients between November 1992 and May 2002. There were no intraoperative complications. One patient developed hemarthrosis 1 week postoperatively and another had a soft tissue hematoma at the incision site. Two patients required a second procedure on the same joint because of trauma that occurred 2 months following surgery. Follow-up data were available on 26 joints during the first year after the procedure. The frequency of hemarthrosis diminished significantly in that first year and was maintained for up to 5 years in all but three joints. Seventy-six percent of evaluable patients (19/25) had stable or improved joint function at their most recent comprehensive clinic visit. Patients whose range of motion worsened were older and required more than one procedure. Conclusions: Arthroscopic synovectomy significantly reduces hemorrhage into the index joint and allows for stabilization of joint range of motion. This procedure should be considered in young hemophilia patients with chronic synovitis.