Arthroscopic Synovectomy in the Treatment of Hemophilic Synovitis

Chronic proliferative synovitis is a frequent complication of hemophilia for which effective treatments are lacking. Over a three year period we employed arthroscopic surgery on 7 knees in 6 patients with hemophilic synovitis refractory to standard treatment including anti-inflammatory drugs, prophylactic factor infusion and physical therapy. Operative findings included diffuse villous synovial proliferation covering most cartilagenous surfaces of joint spaces in all six cases, varying degrees of articular erosion, osteochondral defects, and various forms of meniscal tear. One patient with an advanced degree of arthropathy had an extensive scar and interarticular fibrous band adhesions. Peri-operatively morbidity was minimal, permitting early institution of physical therapy. Joint effusion resolved within one month of surgery. During the 6 month to 3 year post-operative follow-up, bleeding frequency was markedly reduced in all cases. In contradistinction to open surgical synovectomy, which encountered an unacceptably high incidence of post-operative reduction in joint mobility, the range of knee joint motion after arthroscopic synovectomy was well preserved or improved in 4 of 6 patients. Two patients have lost the range of knee joint motion in post-arthroscopic follow-up; one patient sustained a tibial fracture requiring a long leg cast on the same knee, and the other had severe arthropathy with a reduced range of motion prior to arthroscopy. All patients have experienced pain relief and improved knee function. We conclude that arthroscopic synovectomy is a promising treatment of chronic hemophilic synovitis of the knee with low surgical morbidity and with long-term benefit comparable to or better than that reported with open synovectomy.