Radial Head Excision and Synovectomy in Patients with Hemophilia

Silva, Mauricio; Luck Jr., James V.
October 2008
Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p254
Academic Journal
BACKGROUND: Chronic hemophilic synovitis of the elbow usually leads to enlargement and erosion of the radial head, resulting in mechanical blockage of forearm rotation, synovial impingement, recurrent hemarthrosis, and pain. The purpose of the present study was to evaluate the intermediate-term results of radial head excision and synovectomy in a large group of patients with hemophilia who had been managed at a single institution. METHODS: Information on forty radial head excision and synovectomy procedures that had been performed at our institution from 1969 to 2004 was retrospectively collected. All but one of the operations had been performed in patients with severe hemophilia. The mean age of the patients at the time of the procedure was thirty-three years. Pain, limited range of motion, and bleeding were the indications for surgery. The mean duration of follow-up was 7.7 years. RESULTS: Only one postoperative complication was observed: a posterior interosseous nerve palsy that fully resolved by six months. No additional surgical intervention for bleeding was required in sixteen of the nineteen elbows in which bleeding was one of the indications for surgery. Of the forty elbows, seven required a secondary surgical procedure at a mean of five years after the excision of the radial head. Examination of the mean range of motion at the time of the latest follow-up demonstrated a 63° increase in the pronation-supination arc (p < 0.00001) but only a 2° increase in the flexion arc. CONCLUSIONS: Radial head excision in patients with hemophilia is an effective procedure for improving forearm rotation and reducing pain and bleeding frequency, with a low risk of complications. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Localised pigmented villonodular synovitis of the knee. Panakkal, Jiss Joseph; Paul, Suresh; Chandi, Sushil // Kerala Journal of Orthopaedics; 

    Localised pigmented villonodular synovitis (PVNS) of the knee is a rare, idiopathic condition presenting with symptoms that can be confused with various other intra-articular pathologies. The condition is usually monoarticular, the knee being most commonly affected. If totally excised, complete...

  • Idiopathic immune-mediated polysynovitis in three horses. Pusterla, N.; Pratt, S. M.; Magdesian, K. G.; Carlson, G. P. // Veterinary Record: Journal of the British Veterinary Association;Jul2006, Vol. 159 Issue 1, p13 

    This paper describes the clinical, laboratory and histological findings in three horses with immune-mediated polysynovitis; they had lost weight, suffered intermittent fever, were lethargic and stiff, and had effusions in several joints. Laboratory abnormalities included anaemia, leucocytosis,...

  • Biologic therapy in refractory chronic non-bacterial osteomyelitis of childhood. Eleftheriou, Despina; Gerschman, Tommy; Sebire, Neil; Woo, Patricia; Pilkington, Clarissa A.; Brogan, Paul A. // Rheumatology;Aug2010, Vol. 49 Issue 8, p1505 

    Objective. To date there is no uniformly effective treatment for either chronic recurrent multifocal osteomyelitis (CRMO) or synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. We report on our clinical experience of using biologic therapy to treat children with these...

  • SAPHO SYNDROME: MISDIAGNOSED AND OPERATED. Karadag-Saygi, Evrim; Gunduz, O. Hakan; Gumrukcu, Gulistan; Akyuz, Gulseren // Acta Reumatológica Portuguesa;2008, Vol. 33 Issue 4, p460 

    SAPHO is a rare disorder that results in synovitis, acne, pustulosis, hyperostosis and osteitis. Patients with this syndrome typically present with musculoskeletal complaints, frequently localized to the anterior chest wall. However, diagnosis can be difficult in case of involvement of only one...

  • Pigmented villonodular synovitis of the temporomandibular joint: A report of two cases. Church, Christopher A.; Rowe, Mark; Llaurado, Raymund; Liwnicz, Boleslaw H.; Martin, Paul A. // ENT: Ear, Nose & Throat Journal;Sep2003, Vol. 82 Issue 9, p692 

    Pigmented villonodular synovitis is a benign but locally destructive disease that originates in the synovial membranes of the joints. It is a proliferative disorder of unknown etiology, and it is usually monarthric. Approximately 80% of cases involve the knee; the hip, ankle, foot, hand, elbow,...

  • A case of co-existing pigmented villonodular synovitis and tuberculosis infection of the footand ankle. Tun Hing Lui; Lau Wai Yip Stephen // Archives of Orthopaedic & Trauma Surgery;Aug2008, Vol. 128 Issue 8, p769 

    A woman presented with chronic left ankle pain and swelling with no systemic upset. Magnetic resonance imaging suggested pigmented villonodular synovitis (PVNS) of her left ankle joint and flexor hallucis longus tendon. Combined arthroscopic and open synovectomy was performed. Histological...

  • Case report: rheumatoid arthritis occurring during observation after surgery for localized pigmented villonodular synovitis. Hirose, Isao; Mori, Yujiro; Fujimoto, Akihiko // Modern Rheumatology (Springer Science & Business Media B.V.);Sep2003, Vol. 13 Issue 3, p281 

    In the rare case presented here, arthroscopic resection was performed after a diagnosis of localized pigmented villonodular synovitis (LPVS) of the knee, but the disorder recurred after about 1 year as the diffuse form, and synovectomy was performed through a medial parapatella incision....

  • Pigmented villonodular synovitis: a retrospective study of seventy five cases (eighty one joints). Ma, Xiaomei; Shi, Guodong; Xia, Chunyan; Liu, Huimin; He, Jin; Jin, Wentao // International Orthopaedics;Jun2013, Vol. 37 Issue 6, p1165 

    Purpose: Pigmented villonodular synovitis (PVNS) is a relatively rare, benign proliferation lesion of the synovium of large joints, but there is not much information available about the disease's aetiology, clinical history, differential diagnosis, treatment, and long-term effects. We conducted...

  • Pigmented villonodular synovitis originating from the lumbar facet joint: a case report. Oe, Kenichi; Sasai, Kunihiko; Yoshida, Yugo; Ohnari, Hiroyuki; Iida, Hirokazu; Sakaida, Noriko; Uemura, Yoshiko // European Spine Journal;Dec2007 Supplement 3, Vol. 16, p301 

    The authors successfully treated a rare case of pigmented villonodular synovitis (PVNS) that originated from the lumbar facet joint (L4-5). A 43-year-old man presented with a complaint of left severe sciatica causing difficulty in walking. Magnetic resonance imaging (MRI) demonstrated an...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics