J Korean Orthop Assoc.  2014 Dec;49(6):463-470. 10.4055/jkoa.2014.49.6.463.

Short-Term Outcomes of Arthroscopic Synovectomy for Hemophilic Ankle Arthropathy

• Lee JH
• Chung DW
• Kim DH

• KMID: 2185160
• DOI: http://doi.org/10.4055/jkoa.2014.49.6.463

Abstract

PURPOSE
This study reports on the results of clinical and radiological evaluation of arthroscopic synovectomy in hemophilic ankle arthropathy.
MATERIALS AND METHODS
Between September 2006 and December 2008, arthroscopic synovectomy was performed on 35 ankle joints in 33 patients with hemophilic ankle arthropathy. The mean follow-up period was 30 months. The range of motion of joint and frequency of intra-articular bleeding and factor dose were evaluated for this study. American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind foot score and subjective satisfaction were used for clinical assessment. Arnolf and Hilgartner classification was used for radiological assessment.
RESULTS
The mean dorsiflexion and plantar flexion were 10.1degrees, 30.1degrees, respectively, at preoperation and 11.3degrees, 28.2degrees, respectively on the final day of follow-up with no significant difference in the range of motion. The mean frequency of hemarthrosis decreased significantly to 0.6 times per month postoperative (p<0.05). The mean amount of factor replacement decreased from 5,320 units/mo preoperative to 4,568 units/mo postoperative with no significance difference. AOFAS ankle and hind foot score was improved to 90 points postoperative with significance. On radiologic evaluation, 33 cases showed no significant changes, while two cases had progressed at the last follow-up.
CONCLUSION
Arthroscopic synovectomy for recurrent hemarthrosis in hemophilic ankle arthropathy is a useful method for familiar procedure, decreasing bleeding episodes and subjective satisfaction.

Keyword

ankle joint; hemophilia; arthroscopic synovetomy

MeSH Terms

Ankle Joint
Ankle*
Classification
Follow-Up Studies
Foot
Hemarthrosis
Hemophilia A
Hemorrhage
Humans
Joints
Range of Motion, Articular

Figure

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  Figure 1 (A) Preoperative antero-posterior and lateral radiographs of a 19-year-old boy show that there is no joint space narrowing and cyst. (B) Arthroscopic finding shows moderate synovial hypertrophy and synovial band formation.

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  Figure 2 Serial outcomes of bleeding frequency.

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  Figure 3 (A) Preoperative antero-posterior and lateral radiographs of a 17-year-old boy showing narrow joint space and anterior beaking of the talus. (B) Arthroscopic finding shows synovial proliferation. We performed synovectomy. (C) Two years later, this radiographs show no evidence of disease progression.

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