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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2015

01-03-2015 | Knee

Arthroscopic partial anterior synovectomy of the knee on patients with haemophilia

Authors: Adriano Marques de Almeida, Marcia Uchoa de Rezende, Felippi Guizardi Cordeiro, Paula Ribeiro Villaça, Elbio Antonio D’Amico, Arnaldo José Hernandez, Gilberto Luis Camanho

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2015

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Abstract

Purpose

This study assessed the results of two-portal knee arthroscopic synovectomy in terms of bleeding recurrence, knee function, quality of life (QOL), and radiographic staging in a prospective case series of patients with haemophilia.

Methods

Nine knees from eight patients (median age 16.1 years; range 9.6–25 years) with haemophilia and recurrent knee haemarthrosis were prospectively evaluated. Yearly recurrence of bleeding was evaluated once a year for 5 years postoperatively. Range of motion (ROM) and radiographic staging, as well as results of the short form (SF)-36 and subjective knee form of the International Knee Documentation Committee (IKDC) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires, were evaluated before surgery and at the end of follow-up.

Results

Mean bleeding recurrence was significantly reduced during the 5-year follow-up period. Questionnaire results showed significant improvements (IKDC P = 0.015, WOMAC P = 0.011, and SF-36 P = 0.023), whereas ROM was not significantly affected. Arthropathy progressed from Arnold–Hilgartner radiographic stage III to stage IV (P = 0.0082).

Conclusions

Two-portal knee arthroscopic synovectomy was effective at reducing bleeding recurrence and improving knee function and QOL in patients with haemophilia, but did not interrupt the progression of radiographic changes.

Level of evidence

Case series, Level IV.
Literature
1.
go back to reference Acharya SS (2012) Exploration of the pathogenesis of haemophilic joint arthropathy: understanding implications for optimal clinical management. Br J Haematol 156:13–23CrossRefPubMed Acharya SS (2012) Exploration of the pathogenesis of haemophilic joint arthropathy: understanding implications for optimal clinical management. Br J Haematol 156:13–23CrossRefPubMed
2.
go back to reference Arnold WD, Hilgartner MW (1977) Hemophilic arthropathy. Current concepts of pathogenesis and management. J Bone Joint Surg Am 59:287–305PubMed Arnold WD, Hilgartner MW (1977) Hemophilic arthropathy. Current concepts of pathogenesis and management. J Bone Joint Surg Am 59:287–305PubMed
3.
go back to reference Ciconelli R, Ferraz M, Santos W, Meinão I, Quaresma M (1999) Brazilian-portuguese version of the SF-36. A reliable and valid quality of life outcome measure. Rev Bras Reumatol 39:143–150 Ciconelli R, Ferraz M, Santos W, Meinão I, Quaresma M (1999) Brazilian-portuguese version of the SF-36. A reliable and valid quality of life outcome measure. Rev Bras Reumatol 39:143–150
4.
go back to reference Dunn AL, Busch MT, Wyly JB, Sullivan KM, Abshire TC (2004) Arthroscopic synovectomy for hemophilic joint disease in a pediatric population. J Pediatr Orthop 24:414–426CrossRefPubMed Dunn AL, Busch MT, Wyly JB, Sullivan KM, Abshire TC (2004) Arthroscopic synovectomy for hemophilic joint disease in a pediatric population. J Pediatr Orthop 24:414–426CrossRefPubMed
5.
go back to reference Eickhoff HH, Koch W, Raderschadt G, Brackmann HH (1997) Arthroscopy for chronic hemophilic synovitis of the knee. Clin Orthop Relat Res 343:58–62PubMed Eickhoff HH, Koch W, Raderschadt G, Brackmann HH (1997) Arthroscopy for chronic hemophilic synovitis of the knee. Clin Orthop Relat Res 343:58–62PubMed
6.
go back to reference Feldman BM, Berger K, Bohn R, Carcao M, Fischer K, Gringeri A et al (2012) Haemophilia prophylaxis: how can we justify the costs? Haemophilia 18:680–684CrossRefPubMed Feldman BM, Berger K, Bohn R, Carcao M, Fischer K, Gringeri A et al (2012) Haemophilia prophylaxis: how can we justify the costs? Haemophilia 18:680–684CrossRefPubMed
7.
go back to reference Ferretti M, Gassner R, Wang Z, Perera P, Deschner J, Sowa G et al (2006) Biomechanical signals suppress proinflammatory responses in cartilage: early events in experimental antigen-induced arthritis. J Immunol 177:8757–8766CrossRefPubMed Ferretti M, Gassner R, Wang Z, Perera P, Deschner J, Sowa G et al (2006) Biomechanical signals suppress proinflammatory responses in cartilage: early events in experimental antigen-induced arthritis. J Immunol 177:8757–8766CrossRefPubMed
8.
go back to reference Gringeri A, Lundin B, von Mackensen S, Mantovani L, Mannucci PM (2011) A randomized clinical trial of prophylaxis in children with hemophilia A (the ESPRIT Study). J Thromb Haemost 9:700–710CrossRefPubMed Gringeri A, Lundin B, von Mackensen S, Mantovani L, Mannucci PM (2011) A randomized clinical trial of prophylaxis in children with hemophilia A (the ESPRIT Study). J Thromb Haemost 9:700–710CrossRefPubMed
9.
go back to reference Ivanovith M (2002) Brazilian-portuguese translation and validation of the Western-Ontario and McMaster Universities Osteoarthritis Index (WOMAC). [dissertation]. São Paulo: Universidade Federal de São Paulo Ivanovith M (2002) Brazilian-portuguese translation and validation of the Western-Ontario and McMaster Universities Osteoarthritis Index (WOMAC). [dissertation]. São Paulo: Universidade Federal de São Paulo
10.
go back to reference Journeycake JM, Miller KL, Anderson AM, Buchanan GR, Finnegan M (2003) Arthroscopic synovectomy in children and adolescents with hemophilia. J Pediatr Hematol Oncol 25:726–731CrossRefPubMed Journeycake JM, Miller KL, Anderson AM, Buchanan GR, Finnegan M (2003) Arthroscopic synovectomy in children and adolescents with hemophilia. J Pediatr Hematol Oncol 25:726–731CrossRefPubMed
11.
go back to reference Kim HC, Klein K, Hirsch S, Seibold JR, Eisele J, Saidi P (1984) Arthroscopic synovectomy in the treatment of hemophilic synovitis. Scand J Haematol 40:271–279 Kim HC, Klein K, Hirsch S, Seibold JR, Eisele J, Saidi P (1984) Arthroscopic synovectomy in the treatment of hemophilic synovitis. Scand J Haematol 40:271–279
12.
go back to reference Klamroth R, Pollmann H, Hermans C, Faradji A, Yarlas AS, Epstein JD et al (2011) The relative burden of haemophilia A and the impact of target joint development on health-related quality of life: results from the ADVATE Post-Authorization Safety Surveillance (PASS) study. Haemophilia 17:412–421CrossRefPubMed Klamroth R, Pollmann H, Hermans C, Faradji A, Yarlas AS, Epstein JD et al (2011) The relative burden of haemophilia A and the impact of target joint development on health-related quality of life: results from the ADVATE Post-Authorization Safety Surveillance (PASS) study. Haemophilia 17:412–421CrossRefPubMed
13.
go back to reference Klein KS, Aland CM, Kim HC, Eisele J, Saidi P (1987) Long term follow-up of arthroscopic synovectomy for chronic hemophilic synovitis. Arthroscopy 3:231–236CrossRefPubMed Klein KS, Aland CM, Kim HC, Eisele J, Saidi P (1987) Long term follow-up of arthroscopic synovectomy for chronic hemophilic synovitis. Arthroscopy 3:231–236CrossRefPubMed
14.
go back to reference Limbird TJ, Dennis SC (1987) Synovectomy and continuous passive motion (CPM) in hemophiliac patients. Arthroscopy 3:74–79CrossRefPubMed Limbird TJ, Dennis SC (1987) Synovectomy and continuous passive motion (CPM) in hemophiliac patients. Arthroscopy 3:74–79CrossRefPubMed
15.
go back to reference Metsavaht L, Leporace G, Riberto M, de Mello Sposito MM, Batista LA (2010) Translation and cross-cultural adaptation of the Brazilian version of the International Knee Documentation Committee Subjective Knee Form: validity and reproducibility. Am J Sports Med 38:1894–1899CrossRefPubMed Metsavaht L, Leporace G, Riberto M, de Mello Sposito MM, Batista LA (2010) Translation and cross-cultural adaptation of the Brazilian version of the International Knee Documentation Committee Subjective Knee Form: validity and reproducibility. Am J Sports Med 38:1894–1899CrossRefPubMed
16.
go back to reference Montane I, McCollough NC 3rd, Lian EC (1986) Synovectomy of the knee for hemophilic arthropathy. J Bone Joint Surg Am 68:210–216PubMed Montane I, McCollough NC 3rd, Lian EC (1986) Synovectomy of the knee for hemophilic arthropathy. J Bone Joint Surg Am 68:210–216PubMed
17.
go back to reference Poggini L, Chistolini A, Mariani G, Mariani PP (1989) Arthroscopic synovectomy in the treatment of haemophilic arthropathy: preliminary results in eight patients. Ital J Orthop Traumatol 15:457–461PubMed Poggini L, Chistolini A, Mariani G, Mariani PP (1989) Arthroscopic synovectomy in the treatment of haemophilic arthropathy: preliminary results in eight patients. Ital J Orthop Traumatol 15:457–461PubMed
18.
go back to reference Post M, Watts G, Telfer M (1986) Synovectomy in hemophilic arthropathy. A retrospective review of 17 cases. Clin Orthop Relat Res 202:139–146PubMed Post M, Watts G, Telfer M (1986) Synovectomy in hemophilic arthropathy. A retrospective review of 17 cases. Clin Orthop Relat Res 202:139–146PubMed
19.
go back to reference Rippey JJ, Hill RR, Lurie A, Sweet MB, Thonar EJ, Handelsman JE (1978) Articular cartilage degradation and the pathology of haemophilic arthropathy. S Afr Med J 54:345–351PubMed Rippey JJ, Hill RR, Lurie A, Sweet MB, Thonar EJ, Handelsman JE (1978) Articular cartilage degradation and the pathology of haemophilic arthropathy. S Afr Med J 54:345–351PubMed
20.
go back to reference Rodriguez-Merchan EC (2012) Differing approaches to diagnosis and treatment of musculoskeletal complications of haemophilia in resource-rich and resource-limited settings. Blood Coagul Fibrinolysis 23:575–579CrossRefPubMed Rodriguez-Merchan EC (2012) Differing approaches to diagnosis and treatment of musculoskeletal complications of haemophilia in resource-rich and resource-limited settings. Blood Coagul Fibrinolysis 23:575–579CrossRefPubMed
21.
go back to reference Rodriguez-Merchan EC (1996) Effects of hemophilia on articulations of children and adults. Clin Orthop Relat Res 328:7–13CrossRefPubMed Rodriguez-Merchan EC (1996) Effects of hemophilia on articulations of children and adults. Clin Orthop Relat Res 328:7–13CrossRefPubMed
22.
go back to reference Rodriguez-Merchan EC (2012) Prevention of the musculoskeletal complications of hemophilia. Adv Prev Med 2012:201–207CrossRef Rodriguez-Merchan EC (2012) Prevention of the musculoskeletal complications of hemophilia. Adv Prev Med 2012:201–207CrossRef
23.
go back to reference Roosendaal G, van Rinsum AC, Vianen ME, van den Berg HM, Lafeber FP, Bijlsma JW (1999) Haemophilic arthropathy resembles degenerative rather than inflammatory joint disease. Histopathology 34:144–153CrossRefPubMed Roosendaal G, van Rinsum AC, Vianen ME, van den Berg HM, Lafeber FP, Bijlsma JW (1999) Haemophilic arthropathy resembles degenerative rather than inflammatory joint disease. Histopathology 34:144–153CrossRefPubMed
24.
25.
go back to reference Storti E, Traldi A, Tosatti E, Davoli PG (1969) Synovectomy, a new approach to haemophilic arthropathy. Acta Haematol 41:193–205CrossRefPubMed Storti E, Traldi A, Tosatti E, Davoli PG (1969) Synovectomy, a new approach to haemophilic arthropathy. Acta Haematol 41:193–205CrossRefPubMed
26.
go back to reference Tamurian RM, Spencer EE, Wojtys EM (2002) The role of arthroscopic synovectomy in the management of hemarthrosis in hemophilia patients: financial perspectives. Arthroscopy 18:789–794CrossRefPubMed Tamurian RM, Spencer EE, Wojtys EM (2002) The role of arthroscopic synovectomy in the management of hemarthrosis in hemophilia patients: financial perspectives. Arthroscopy 18:789–794CrossRefPubMed
27.
go back to reference Triantafyllou SJ, Hanks GA, Handal JA, Greer RB 3rd (1992) Open and arthroscopic synovectomy in hemophilic arthropathy of the knee. Clin Orthop Relat Res 283:196–204PubMed Triantafyllou SJ, Hanks GA, Handal JA, Greer RB 3rd (1992) Open and arthroscopic synovectomy in hemophilic arthropathy of the knee. Clin Orthop Relat Res 283:196–204PubMed
28.
go back to reference Verma N, Valentino LA, Chawla A (2007) Arthroscopic synovectomy in haemophilia: indications, technique and results. Haemophilia 3:38–44CrossRef Verma N, Valentino LA, Chawla A (2007) Arthroscopic synovectomy in haemophilia: indications, technique and results. Haemophilia 3:38–44CrossRef
29.
go back to reference Wiedel JD (1985) Arthroscopic synovectomy for chronic hemophilic synovitis of the knee. Arthroscopy 1:205–209CrossRefPubMed Wiedel JD (1985) Arthroscopic synovectomy for chronic hemophilic synovitis of the knee. Arthroscopy 1:205–209CrossRefPubMed
30.
go back to reference Wiedel JD (1984) Arthroscopic synovectomy in hemophilic arthropathy of the knee. Scand J Haematol 40:263–270 Wiedel JD (1984) Arthroscopic synovectomy in hemophilic arthropathy of the knee. Scand J Haematol 40:263–270
Metadata
Title
Arthroscopic partial anterior synovectomy of the knee on patients with haemophilia
Authors
Adriano Marques de Almeida
Marcia Uchoa de Rezende
Felippi Guizardi Cordeiro
Paula Ribeiro Villaça
Elbio Antonio D’Amico
Arnaldo José Hernandez
Gilberto Luis Camanho
Publication date
01-03-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2706-6

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