Synovectomy in hemophilic arthropathy. A retrospective review of 17 cases.

Seventeen patients with severe hemophilic synovitis were reviewed for an average of 59.6 months after surgical synovectomy to record radiographic progression of arthropathic changes, frequency of hemarthroses, and range of motion. There were 12 knees and five elbows in the study. Most joints showed some radiographic progression of the arthropathy. In aged patients, two knees progressed to end-stage disease. The frequency of hemarthroses was greatly decreased in all joints and especially in the elbow. Range of motion was preserved for most knees but was reduced significantly for the elbow. Three of five elbows had additional procedures. This factor may be responsible, in part, for lost motion in the elbow as compared to the relatively good results in the knee having had true synovectomy. While the incidence of bleeding is significantly decreased after surgical synovectomy, it is not necessarily associated with a cessation of the progression of joint pathology. Reduced incidence of bleeds following postsurgical synovectomy may serve to delay reconstructive operations until a later period in life. Eventually, the disease proceeds to end-stage arthropathy as joint function correspondingly decreases with age. Early surgical synovectomy for intractable chronic synovitis is recommended as a useful measure in the management of hemophilic arthropathy. Patients should be treated conservatively with therapeutic doses of factor concentrate replacement for a reasonable period of time in an effort to obviate surgical treatment.