Arthroscopic Synovectomy of the Knee in Hemophilia

Abstract

Nine knees in 8 patients with severe hemophilia A and 1 patient with hemophilia B underwent arthroscopic synovectomy during the period of 1980 to 1985. This group of patients has been observed prospectively for the past 10 to 15 years. One complication occurred immediately postoperatively in an 8-year-old boy in whom a severe hemarthrosis developed that required arthroscopic evacuation. His postoperative recovery was compromised leading to significant loss of motion. Recurrent hemarthroses developed in only 1 patient after an injury to the knee. A second arthroscopic synovectomy was performed 45 months after the initial procedure. Other than the patient who lost motion after the postoperative complication, all patients initially regained or improved their range of motion. The latest followup, however, showed several patients losing motion which correlated with clinical and radiographic evidence of progressive changes of the hemophilic arthropathy. The 1 patient with Factor IX deficiency required a total knee replacement 8 years after synovectomy. Arthroscopic synovectomy was effective in reducing recurrent hemarthrosis and maintaining range of motion; however, joint deterioration continued to occur although probably at a slower rate.