Intended for US audience only.
Treating Joint Damage1,2
Repeated bleeding episodes in the same joint can cause the synovial membrane surrounding the joint to thicken and become inflamed. As a result, the synovial fluid no longer lubricates the joint's cartilage. This condition, called synovitis, causes problems ranging from pain and loss of motion to crippling arthritis.
Synovectomy
For some people, a procedure called a synovectomy is helpful. With a synovectomy, excess synovial tissue is removed. A thin layer of healthy synovium grows back after the procedure, and the joint often experiences fewer bleeds.
A synovectomy may be done in one of three ways.
Radionuclide Synovectomy — In this procedure, radioactive material called 32P (Phosphorus 32) is injected into the joint. The low levels of radiation emitted by the 32P slow growth of new synovial cells that would cause more thickening. Following this outpatient procedure, patients go home with a splint or cast, which is worn for 2 to 5 days.
Arthroscopic Synovectomy — With arthroscopic synovectomy, a small metal tube is inserted through 2 or 3 very small incisions in the joint. The excess synovial membrane is removed through this tube. This procedure is effective in reducing the number of bleeds and maintaining or improving range of motion in the joint.
Because the joint is not opened, recovery time is shorter than with open surgery, about 3 to 4 weeks. However, removal of all the excess synovial tissue is more difficult through the tube than with open surgery.
Open Synovectomy — In open synovectomy, the joint is surgically opened through an incision. This allows clear access to the joint so all the damaged tissue can be found and removed.
Because of the incision and the fact that the actual joint capsule is opened, there is a 2 to 3 month recovery time. Some loss of motion may also occur with open synovectomy.
Which type of synovectomy would be best for you? Consult with your treatment center, physician, and orthopedic surgeon.
Orthopedic surgery
Sometimes damage to a joint is so severe that infusions of factor and synovectomies are no longer options. In these cases, orthopedic surgery may be the best choice to provide relief and improve movement.
Arthrodesis, or fusion, is used to control pain and bleeding, particularly in the ankles. Arthrodesis uses staples, screws, or even bone grafting to ensure that the joint fuses correctly. Many patients are able to hike or bike for miles after this procedure.
Total joint replacement is a surgery in which the joint is removed and replaced with an artificial joint made of metal, ceramic, or plastic called a prosthesis. Large joints such as the knee, hip, or shoulder are the best candidates for this procedure.
The key to success with any of these procedures is good follow-up care. This means a commitment to regular factor treatment following the operation and a regimen of physical therapy.
He has rid himself of crutches and hopes soon to walk without a cane. "I love to golf and fish and intend to keep right on doing them," he says.
Tracking bleeds and infusions is an important part of maintaining a healthy lifestyle for people with hemophilia. To learn about an easier way to log bleeds and infusions, visit Advoy.com.
References
- WFH publication: “Articular Bleeding (Hemarthrosis) in Hemophilia. An Orthopedist's point of view.” Treatment of Hemophilia Series. April 2008. Number 23. Can be downloaded from the WFH website. Available at http://www.wfh.org. Accessed August 10, 2008.
- An informative resource is the section on “The Complications of Hemophilia” on the Canadian Hemophilia Society website; specifically the section on “Damage to joints”. Available at http://www.hemophilia.ca. Accessed August 7, 2008.
