Arthroscopic synovectomy for hemophilic arthropathy of hemophiliacs inTaiwan

Introduction:Hemophilic arthropathy is a common complication resulting fromrecurrent hemarthrosis in hemophiliacs. Arthroscopic synovectomy is a relativelysimple, less traumatic procedure for hemophilic arthropathy. However, reports onarthroscopic synovectomy for hemophilic arthropathy in Asian countries are relativelylimited compared to those from the West.Materials and methods:From August, 2011 to August, 2013, there were 10 severe-type Taiwanese hemophiliacs (8 hemophilia A, 2 hemophilia B) receiving arthroscopicsynovectomy and enrolled in this study, who had recurrent bleeding with chronicsynovitis that did not respond to secondary prophylactic factor replacement, andphysiotherapy. Following their operation, all patients received prophylaxis with factorreplacement and physiotherapy. Outcome data including joint pain, the frequency ofbleeding and factor injection, and range of motion (ROM) were analyzed.Results:The average age was 23.6 years old, ranging from 15 to 28. A total of 12joints (4 knees, 4 elbows, 3 ankles, one shoulder) received surgery. With all the jointsthere was a reduction of joint pain, frequency of bleeding and factor injection, andimprovement of ROM after operation. No complications were found. Six joints gotsignificant pain relief (3 knees, one elbow, one ankle, one shoulder). With another 6joints, there was partial pain relief with residual pain at a different location (3 elbows,2 ankles, one knee). Residual pain from concurrent early arthritis was confirmed on 3elbows and 1 ankle. Residual pain from residual reactive synovitis was identified on 1knee and 1 ankle.Conclusions:This is the first report of Taiwanese hemophiliacs receiving arthroscopicsynovectomy for hemophilic arthropathy. The effects of arthroscopic synovectomyincluded reduced joint pain, frequency of bleeding and factor use, and improvement ofROM. Concurrent early arthritis is the most common cause of post-synovectomy jointpain. We suggest that synovectomy should be performed earlier before concurrentearly arthritis develops.Haemophilia(2014),20(Suppl. 3), 1--186©2014 The AuthorsHaemophilia©2014 John Wiley & Sons Ltd72MUSCULOSKELETAL ISSUES