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
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
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.
ORIGINAL ABSTRACT CITATION:"Radial Head Excision and Synovectomy in
Patients with Hemophilia"