Treatment options for haemophilic arthropathy of the elbow after failed conservative therapy

A. C. Strauss; G. Goldmann; S. Ezziddin; R. Placzek; M. C. Müller; R. Pflugmacher; J. Oldenburg; P. H. Pennekamp

doi:10.5482/HAMO-14-01-0009

Hämostaseologie, Inhaltsverzeichnis

Hamostaseologie 2014; 34(S 01): S17-S22
DOI: 10.5482/HAMO-14-01-0009

Original article

Schattauer GmbH

Treatment options for haemophilic arthropathy of the elbow after failed conservative therapy

A single centre experienceKlinische Ergebnisse unterschiedlicher Behandlungsoptionen der hämophilen Arthropathie des Ellenbogengelenks nach fehlgeschlagener konservativer Therapie

Authors

A. C. Strauss

¹Department of Orthopaedics and Trauma Surgery, University of Bonn, Germany
G. Goldmann

²Institute for Experimental Haematology and Transfusion Medicine, University of Bonn
S. Ezziddin

³Department of Nuclear Medicine, University of Bonn
R. Placzek

¹Department of Orthopaedics and Trauma Surgery, University of Bonn, Germany
M. C. Müller

¹Department of Orthopaedics and Trauma Surgery, University of Bonn, Germany
R. Pflugmacher

¹Department of Orthopaedics and Trauma Surgery, University of Bonn, Germany
J. Oldenburg

²Institute for Experimental Haematology and Transfusion Medicine, University of Bonn
P. H. Pennekamp

¹Department of Orthopaedics and Trauma Surgery, University of Bonn, Germany

Abstract

Summary

After ankle and knee, the elbow is the most frequent joint affected by haemophilic arthropathy. objective: The objective of this retrospective single centre study is to evaluate the results of treatment of elbow arthropathy after failed conservative therapy. Patients, methods: In 21 consecutive patients, 11 radiosyn-oviortheses (RSO), four arthroscopic and six open synovectomies were performed, among them four with additional resection of the radial head. The mean duration of follow-up was 4.8 (RSO) and 5.3 years (surgery), respectively. Pain status (visual analogue scale, VAS), bleeding frequency, range of motion (ROM) as well as patient satisfaction were evaluated. Results: Both, RSO and surgical synovectomy, achieved a significant reduction of pain and bleeding frequency (p < 0.05). Surgical synovectomies were associated with a marked yet not statistically significant increase of postoperative ROM. Radial head resection improved forearm rotation in all cases. No complications occurred. 20 out of 21 patients were satisfied or highly satisfied with the result of the treatment and would undergo the respective procedure again. Conclusion: Due to the effectiveness and safety RSO is considered to be the primary treatment option in haemophilic arthropathy of the elbow after failed conservative therapy. Arthroscopic synovectomy should be considered if RSO shows inadequate effect or in the presence of contraindications. Open synovectomy with resection of the radial head yields good results in the case of advanced arthropathy with radial head impingement.

Zusammenfassung

Neben dem oberen Sprung- und Kniegelenk ist das Ellenbogengelenk häufig von der hämophilen Arthropathie betroffen. Ziel der Studie ist, die eigenen Behandlungsergebnisse der Ellenbogengelenksarthropathie zu evaluieren und einen Behandlungsalgorithmus vorzuschlagen. Patienten, Material, Methoden: Anhand einer retrospektiven Untersuchung wurden die Behandlungsergebnisse von 21 konsekutiven Patienten evaluiert. Es wurden 11 Radiosynoviorthesen (RSO), vier arthroskopische und sechs offene Synovialektomien, darunter vier mit zusätzlicher Radiuskopfresektion durchgeführt. Der durchschnittliche Nachuntersuchungszeitraum betrug 4,8 Jahre nach RSO und 5,3 Jahre nach Operation. Es wurden die Parameter Schmerz (VAS-Score), Blutungsfrequenz, Bewegungsumfang (ROM) und die subjektive Patientenzufriedenheit bestimmt. Ergebnisse: Sowohl die RSO als auch die operativen Synovektomien führten zur signifikanten Reduktion von Schmerz und Blutungsfrequenz. Durch die operativen Eingriffe verbesserte sich die globale Gelenkfunktion tendenziell, während die Resektion des Radiuskopfes die Pro- und Supination signifikant verbesserte. Komplikationen traten in keinem Fall auf. 20 von 21 Patienten waren mit dem Behandlungsergebnis zufrieden oder sehr zufrieden und würden den jeweiligen Eingriff wiederholen lassen. Schlussfolgerung: Die RSO ist aufgrund ihrer Effektivität und Sicherheit bei konservativ therapieresistenter Synovialitis als primäre Therapieoption zu empfehlen. Bei unzureichender Wirkung ist eine arthroskopische Sy-novektomie zu erwägen, wobei wie bei der RSO keine wesentliche Funktionsverbesserung des Gelenks zu erwarten ist. Die isolierte offene Synovektomie sollte nur in Kombination mit arthroplastischen Eingriffen am Ellenbogengelenk, wie z.B. der Radiuskopfresektion, durchgeführt werden.

Keywords

Elbow - haemophilia - arthropathy - treatment

Schlüsselwörter

Ellenbogen - Hämophilie - Arthropathie - Behandlung

Volltext

Referenzen

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