Arthroscopic Synovectomy in Children and Adolescents With Hemophilia

Journeycake, Janna M.; Miller, Kim L.; Anderson, Alice M.; Buchanan, George R.; Finnegan, Maureen

doi:10.1097/00043426-200309000-00010

Cited by 59 publications

(57 citation statements)

References 20 publications

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“…The study by Journeycake et al evaluated outcome of 27 (11 knees, 12 ankles, 5 elbows) arthroscopic synovectomies in haemophilic synovitis. They reported that the frequency of haemarthroses diminished significantly in that first year and was maintained for up to 5 years in all but three joints [24]. Wiedel also reported a 10-15 year-followup of nine arthroscopic synovectomies of knees that, though successful in controlling recurrent haemarthroses and probably slowing progression, arthroscopic synovectomy did not halt the development of haemophilic arthropathy [25].…”

Section: Discussionmentioning

confidence: 99%

Survival analysis of Y‐90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10‐year retrospective review

et al. 2013

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Despite recent advances including new therapeutic options and availability of primary prophylaxis in haemophiliacs, haemophilic synovitis is still the major clinical problem in significant patient population worldwide. We retrospectively reviewed our 10-year experience with Y-90 radiosynovectomy to determine the outcome in the knee joints of patients with haemophilic synovitis. Between 2002 and 2012, 82 knee joints of 67 patients with haemophilic synovitis were treated with Y-90 radiosynovectomy. The mean age was 16.8 ± 7.8 years (range: 5-39 years). The mean follow-up period was 39.6 ± 25.6 months (range: 12-95 months). Failure of therapy represented re-bleeding after a radiosynovectomy was used as an end point in patient time to progression (TTP) analysis. The median TTP was calculated as 72.0 ± 3.6 months (95% CI 64.8-79.1 months) in Kaplan-Meier analysis. The 1, 3 and 5-year survival rates were 89%, 73% and 63% respectively. Longer TTP (hazard ratio for progression, 2.5; P = 0.00) was evident in patients who have greater reduction in bleeding frequency within 6 months after radiosynovectomy. We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion status of joints and the pretreatment bleeding frequency. We concluded that Y-90 radiosynovectomy in knee joint represents an important resource for the treatment of haemophilic synovitis, markedly reducing joint bleeding and long-term durability, irrespective of the radiographic stage and inhibitor status.

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Section: Discussionmentioning

confidence: 99%

Survival analysis of Y‐90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10‐year retrospective review

et al. 2013

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“…FVIII prophylaxis allows aggressive physical rehabilitation to be undertaken [26]. In some patients, the cycle of joint bleeding and inflammation cannot be controlled with prophylaxis alone, and synovectomy may be necessary to reduce recurrent bleeding and slow the progression of joint damage [34]. Two retrospective studies of arthroscopic synovectomy found that this procedure significantly reduces repeated bleeding into target joints and may slow the progression of disabling arthropathy and maintain ROM and joint function [34].…”

Section: Discussionmentioning

confidence: 99%

“…In some patients, the cycle of joint bleeding and inflammation cannot be controlled with prophylaxis alone, and synovectomy may be necessary to reduce recurrent bleeding and slow the progression of joint damage [34]. Two retrospective studies of arthroscopic synovectomy found that this procedure significantly reduces repeated bleeding into target joints and may slow the progression of disabling arthropathy and maintain ROM and joint function [34]. Accumulating evidence suggests that radionuclide synovectomy, which involves instillation of radioactive material into an affected joint to cause sclerosis of the synovium [35], also decreases the rate of bleeding episodes [36–38].…”

Section: Discussionmentioning

confidence: 99%

Controversies regarding the prophylactic management of adults with severe haemophilia A

Valentino

2009

Haemophilia

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“…Moreover, the ROM was not measured separately for dorsiflexion and plantar flexion. Journeycake et al reported improvements in dorsiflexion and plantar flexion after arthroscopic debridement. However, this result was inconsistent among patients, and the number of patients studied was too small for the results to be statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Anterior osteophyte resection of the ankle joint to increase range of motion in haemophilic ankle arthropathy

2019

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Introduction Haemophilic ankle arthropathy may cause joint bleeding, pain, stiffness, erosion and progressive motion limitations, including a decreased range of motion (ROM) secondary to anterior osteophyte impingement. Aim The purpose of this study was to investigate changes in the ROM and symptoms after synovectomy and anterior osteophyte resection for haemophilic ankle arthropathy. Methods We retrospectively reviewed 41 ankles in 35 patients with haemophilic arthropathy who underwent arthroscopic and/or open synovectomy. The mean follow‐up period was 59.5 months. Indications for the procedure included a lack of improvement with conservative management, and the presence of haemarthrosis and arthralgia. We assessed radiographic images, ankle joint range of motion, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle‐Hindfoot score and patients’ subjective satisfaction preoperatively and at the last follow‐up. Results Arthroscopic synovectomy was performed in 32 ankles, open synovectomy in 6, and arthroscopic synovectomy with additional mini‐open debridement in 3. Ankle dorsiflexion improved from a mean of 2.7° preoperatively to a mean of 7.5° at the final follow‐up (P = 0.003), whereas plantar flexion improved from a mean of 30.7° preoperatively to a mean of 32.7° at the final follow‐up (P = 0.276). The AOFAS score improved from 62.2 preoperatively to 79.1 at the final follow‐up (P < 0.001). Patient satisfaction was “excellent” in 11 ankles, “good” in 22, “fair” in 3 and “poor” in 5. Conclusion Arthroscopic and/or open synovectomy with anterior osteophyte resection and early rehabilitation in adolescents and adults with haemophilic ankle arthropathy showed improved ankle dorsiflexion and AOFAS scores.

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Arthroscopic Synovectomy in Children and Adolescents With Hemophilia

Abstract: 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.

Cited by 59 publications

References 20 publications

Survival analysis of Y‐90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10‐year retrospective review

Survival analysis of Y‐90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10‐year retrospective review

Controversies regarding the prophylactic management of adults with severe haemophilia A

Anterior osteophyte resection of the ankle joint to increase range of motion in haemophilic ankle arthropathy

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