Radial Head Excision and Synovectomy in Patients with Hemophilia

Author(s): Silva M, Luck JV

Source: Journal Bone and Joint Surg 89-A (10): 2156-2162, 2007.

Summary:

This retrospective review of radial head excision and synovectomy in patients with hemophilia was performed in 40 elbows of 36 patients at a mean duration of  8 years follow-up (range, 1 to 28 years).  The mean age of the patients at the time of the procedure was 33 years (range, 16 to 72 years).  Eighty-nine percent had hemophilia A and 11 percent had hemophilia B.  A standard Kocher lateral approach was used to resect the radial head and perform the synovectomy.  Physical therapy was started on the fourth postoperative day and maintained for a minimum of eight weeks.  Overall, there were no significant changes in the flexion-extension arc after excision of the radial head.  Whereas, there was a significant increase in the rotation arc of the forearm as evidenced by the mean forearm rotation of 68 degrees preoperatively and 131 degrees at the time of latest follow-up.  Recurrent chronic bleeding was observed in only 16% of the 19 elbows in which bleeding was an original indication for excision of the radial head and synovectomy.  Of the 40 elbows, 18% underwent a secondary surgical procedure at a mean of 5 years.  Three elbows required a radiosynovectomy to control bleeding.  Three elbows developed ulnar neuritis that required ulnar nerve transposition at a mean of 6 years after the index procedure.  One patient underwent a total elbow arthroplasty 5 years after the index procedure.  One patient developed a posterior interosseous nerve palsy that fully resolved by six months.

This study confirms the ability of radial head excision and synovectomy to restore forearm rotation in hemophiliac patients which is maintained at intermediate term follow-up.  In addition, bleeding frequency can be dramatically improved with this procedure.  The authors report that most of their patients had diminished pain although this is poorly documented.  Overall, a low percentage of patients required secondary procedures at 5 years following this procedure.

Hemophiliac, Elbow, Synovectomy, Forearm, Rotation, Radial, Head, Excision


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