Synovectomy and continuous passive motion (CPM) in hemophiliac patients.

Synovectomy of the knee is a procedure that has been used traditionally for the management of arthropathies due to intraarticular bleeding diatheses. Although open synovectomy controls recurrent bleeding problems, the success of this procedure has been limited frequently by disabling stiffness of the joint. In an attempt to improve on the results of open synovectomy, arthroscopic synovectomy was combined with continuous passive motion (CPM) in a prospective surgical and rehabilitation program. Five male patients aged 10 to 35 years, with chronic and/or recurrent hemarthroses due to hemophilia, underwent arthroscopic synovectomy of the knee. CPM was begun in the recovery room and continued for 5-7 days. Each patient had mildly restricted range of motion (ROM) immediately postoperatively as compared with preoperative measurements. Both active and passive ROM improved rapidly with CPM and physical therapy. By 3-6 months postoperatively, all patients except one had achieved an active ROM greater than the preoperative range, and all showed a significant reduction in documented bleeding episodes. The combination of arthroscopic techniques, which result in minimal extraarticular trauma, and immediate mobilization using CPM has been successful in maximizing the benefits and minimizing the complications of synovectomy in the patient with hemorrhagic arthropathy.