title: Open synovectomy of the ankle joint in young haemophiliacs: mid-term to long- term results of a single-centre series of 32 procedures.
abstract: BACKGROUND
  In haemophiliacs, recurrent hemarthrosis and chronic synovitis lead to chronic arthropathy. Synovectomy is indicated when medical treatment fails. Few studies report the results of open synovectomy of the ankle in haemophiliacs with a small number of procedures and also a limited follow-up.
  
  
  OBJECTIVE
  The aim of this paper is to report the long-term results of open surgical synovectomy of the tibio-talar joint.
  
  
  METHODS
  Thirty-two open synovectomies were performed in 21 young haemophiliacs in the same haemophilia center using an antero-lateral and postero-medial approaches. The median follow-up was 15.4 years. Clinical (Petrini scores) and radiological evaluations (Pettersson scores) were made preoperatively and at each multidisciplinary follow-up visit. Wilcoxon and Spearman's tests were used for the statistical analysis.
  
  
  RESULTS
  Preoperative median Petrini score was 6 (range 3-12), and improved at 2 and 5 years follow-up (P = 0.0003 and P = 0.0001 respectively). At 10 and 15 years follow-ups, median score remained below preoperative score (median 3.5, range 0-11). Ten ankles had a follow-up of more than 20 years. Preoperative median Petterson score presented a slight but continuous worsening in the first 2 and 5 years of follow-ups (P = 0.02, P = 0.003), but not correlation between clinical and radiological results was observed.
  
  
  CONCLUSIONS
  Our long-term results support that clinical scores are improved even if radiological scores progress. Open synovectomy retards the progression of the arthropathy, but not stops it. Bleeding and pain are controlled and even if recurrence of bleedings is frequent, it is less severe, less painful and requiring less factors replacement.
authors.affiliation: Department of Orthopaedics and Traumatology, Complejo Asistencial Universitario de Palencia, Palencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Mingo-Robinet
authors.affiliation: Department of Pediatric Orthopedics, Hopital Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Odent
authors.affiliation: Clinical Investigation Unit, Hopital Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Elie
authors.affiliation: Haemophilia Care Centre, Hopital Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France.
authors.forename: M-F
authors.initials: MF
authors.lastname: Torchet
authors.affiliation: Department of Pediatric Orthopedics, Hopital Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Glorion
authors.affiliation: Department of Pediatric Orthopedics, Hopital Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Padovani
authors.affiliation: Haemophilia Care Centre, Hopital Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Rothschild
mesh_terms: D000293:Adolescent; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies
keywords: ankle; arthropathy; haemophilia; open synovectomy