Arthroscopic Synovectomy for Hemophilic Joint Disease in a Pediatric Population

Dunn, Amy L.; Busch, Michael T.; Wyly, J. B.; Sullivan, Kevin M.; Abshire, Thomas C.

doi:10.1097/00004694-200407000-00013

Cited by 51 publications

(74 citation statements)

References 31 publications

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“…Unlike many authors [11,13,14,19,21], we did not observe a severe loss of ROM as far as long-term results are concerned. There is between 50 to almost 100% of worsening knees in the literature [11,13,14,19,21]. In our series, at the last follow-up, only two patients had worsened their ROM.…”

Section: Discussioncontrasting

confidence: 94%

“…As with many authors, we agree that synovectomy does not stop the radiographic deterioration of the joint [12,13,21], but only delays its onset. In spite of synovectomy, the natural course of haemophilic knees is towards chronic arthropathy.…”

Section: Discussionsupporting

confidence: 83%

“…The pre-operative median Petrini score was 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)). The youngest patients had the best clinical status (q = 0.66, P \ 0.001).…”

Section: Resultsmentioning

confidence: 99%

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Surgical synovectomy of the knee in young haemophiliacs: Long-term results of a monocentric series of 23 patients

Rampal

Odent

Torchet

et al. 2010

Journal of Children's Orthopaedics

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Background In haemophiliacs, synovectomy is indicated for recurrent joint bleedings, despite medical treatment. Method We report a series of 23 surgical synovectomies of the knee with a median follow-up of 8.8 years. The median age of patients at surgery was 13.5 years. Clinical and radiological evaluations were made according to the Petrini and the Pettersson scores, at 1 and 5 years after surgery, and at the last follow-up. Wilcoxon and Spearman's tests were used for the statistical analysis. Result The Petrini score improved at 1 and 5 years (P \ 0.001). Nine patients have 20 years of follow-up and a stable result. In more than half of the knees, no episode of recurrent bleeding occurred. The effect of surgery on the range of motion (ROM) was moderate and mobilisation under anaesthesia did not improve it significantly. There was a progressive worsening of the radiological score, but no correlation between clinical and radiological score was noticed (q = 0.08, P = 0.77). Conclusion Complete synovectomy gives good long-term results in term of bleeding recurrence and overall function.

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Section: Discussioncontrasting

confidence: 94%

Section: Discussionsupporting

confidence: 83%

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Surgical synovectomy of the knee in young haemophiliacs: Long-term results of a monocentric series of 23 patients

Rampal

Odent

Torchet

et al. 2010

Journal of Children's Orthopaedics

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“…Once a target joint has developed, it may be difficult to stop the cycle of repeated haemarthrosis with prophylactic clotting factor infusions (secondary prophylaxis) (Dunn et al, 2004). Patients who continue to bleed despite a trial of prophylaxis, and those in whom prophylaxis is not available or feasible, are candidates for interventions aimed at halting this cycle.…”

Section: Synovectomymentioning

confidence: 99%

“…Arthroscopic synovectomy has been used most frequently in the knees, but there is increasing experience in the ankles, elbows and shoulders (Patti & Mayo, 1996;Wiedel, 2002;Dunn et al, 2004). Figure 3 shows an arthroscopic view of the inflamed synovium in a patient with haemophilia.…”

Section: Arthroscopic Synovectomymentioning

confidence: 99%

Modern management of haemophilic arthropathy

2007

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SummaryCurrently available factor concentrates for treatment of patients with haemophilia are virally inactivated or are made by recombinant technology and their broad use in developed nations has resulted in the dramatic elimination of the treatment‐related viral illnesses that decimated the haemophilia community in the late 20th century. The major morbidity experienced by patients with haemophilia today is joint disease, a result of repeated bleeding episodes into joint spaces. Although administration of factor concentrates to prevent bleeding has been demonstrated to prevent haemophilic joint disease when applied assiduously, repeated bleeding episodes induce synovitis that is irreversible and may progress despite subsequent prophylaxis. Surgical and nuclear medicine interventions are available to reduce the pain of haemophilic arthropathy and to reduce further bleeding episodes. Patients with high titre inhibitors are at great risk for the development of joint disease and present the greatest therapeutic challenges when joint surgery is needed.

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The aging patient with hemophilia

Konkle¹

2012

American J Hematol

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The prospects for many boys born with hemophilia today include a normal life expectancy and minimal to no joint disease. However, despite the availability of safe replacement clotting factor concentrates and effective antiviral treatment, the aging patient with hemophilia today faces many challenges. These include management of their hemophilia as well as the same age‐related health issues as experienced in the general population. While increasing, data on the prevalence of comorbidities and their management in the hemophilia population remain limited. This review will focus on issues related to management of hemophilia and complications of cardiovascular, musculoskeletal, hepatic, and renal disease. Available research is summarized and potential approaches to management are discussed. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.

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Arthroscopic Synovectomy for Hemophilic Joint Disease in a Pediatric Population

Cited by 51 publications

References 31 publications

Surgical synovectomy of the knee in young haemophiliacs: Long-term results of a monocentric series of 23 patients

Surgical synovectomy of the knee in young haemophiliacs: Long-term results of a monocentric series of 23 patients

Modern management of haemophilic arthropathy

The aging patient with hemophilia

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