Summary
Twenty seven patients with haemophilia who had repeated haemarthroses affecting the knee joint, despite appropriate substitution therapy, were treated by surgical synovectomy. Open operations were carried out on 18 and 9 had an arthroscopic procedure. The average age at the time of synovectomy was 13 years for both the open and arthroscopic groups. The open group was followed up for an average of 15.2 years and the closed for 5.4 years. Operation took 70 minutes on average in the arthroscopic group and 50 minutes in the open. Patients who had an arthroscopy were in hospital for an average of 5 days and those with an open operation for 10. Synovectomy by both methods significantly reduced bleeding episodes. The results were assessed according to the classification recommended by the Orthopaedic Advisory Committee of the World Federation of Haemophilia. In the open group 2 patients had a good result, 10 were fair and 6 poor; in the arthroscopic group 3 had a good result, 5 were fair and 1 poor. Both operations appeared to slow, but did not halt, the radiographic deterioration of the joints.
Résumé
Vingt-sept hémophiles qui présentaient des hémarthroses récidivantes du genou en dépit d'une thérapeutique substitutive appropriée ont été traités par synovectomie chirurgicale, 18 à ciel ouvert et 9 par arthroscopie. L'âge moyen des malades au moment de l'opération était de 13 ans dans les deux groupes, le recul moyen des observations est de 15,2 ans dans le groupe opéré à ciel ouvert et de 5,4 ans dans l'autre, la durée de l'opération a été de 70 minutes dans le groupe arthroscopique et de 50 minutes dans l'autre, l'hospitalisation a été de 5 jours dans le groupe arthroscopique et de dix jours dans l'autre. Les deux techniques ont obtenu la diminution des épisodes hémorragiques. Les résultats ont été évalués selon la cotation du «Comité orthopédique consultatif de la Fédération mondiale de l'Hémophilie»: 2 sont bons, 10 médiocres et 6 mauvais dans le groupe opéré à ciel ouvert et 3 bons, 5 médiocres et 1 mauvais dans le groupe arthroscopique. Ces résultats montrent que les deux techniques peuvent ralentir la détérioration du genou, mais non l'interrompre.
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Merchan, E.C.R., Galindo, E., Ladreda, J.M.M. et al. Surgical synovectomy in haemophilic arthropathy of the knee. International Orthopaedics 18, 38–41 (1994). https://doi.org/10.1007/BF00180177
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DOI: https://doi.org/10.1007/BF00180177