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California HTC Performs Retrospective Review of Elbow Procedures

Researchers from a hemophilia treatment center (HTC) at the Orthopaedic Hospital in Los Angeles recently studied a set of orthopedic procedures carried out on patients with chronic synovitis of the elbow.

Synovitis is a fairly common complication among hemophilia patients. It occurs when multiple bleeds into particular joints, often called "target joints," lead to orthopedic complications. Repeated bleeding into the same joints will often cause the lining (synovium) to become thicker and inflamed. This can result in arthritis-like complications such as pain, and eventually, diminished range of motion and mobility. The ankle, elbow, knee and shoulder are all susceptible to synovitis.

According to the investigators, Mauricio Silva, MD, and James V. Luck, Jr., MD, two procedures that are often performed in combination have been successful in treating patients with hemophilic synovitis in the elbow. The procedures are radial head excision, the removal of the damaged end of the radius (one of the bones of the forearm), and synovectomy, the removal of the synovial membrane that lines the joint.

All the procedures referred to in the study were performed at the Orthopaedic Hospital in Los Angeles. Silva and Luck conducted the retrospective review, looking at 40 of the elbow procedures conducted at the HTC between 1969 and 2004. With the exception of one operation, the procedures were performed on individuals with severe hemophilia. These patients, with a mean age of 33 years at the time of the operation, were all referred for surgery due to bleeding, range of motion issues and pain. The only post-surgery complications that developed were nerve compression and impairment, which were completely resolved within six months. Follow-up examinations revealed increased range of motion--63 degrees in the pronation-supination arc, which refers to opposite (palm down and palm up) rotations of the forearm.

"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," reported Silva and Luck.

The study, "Radial Head Excision and Synovectomy in Patients with Hemophilia," was published in the October 2007 issue of The Journal of Bone and Joint Surgery.

Source: Hematology Week, November 5, 2007


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