title: Benefits of radial head excision in patients with haemophilia: mid-term functional results.
abstract: BACKGROUND
  Recurrent haemarthrosis in haemophilic patients result with arthropathy of the radiocapitellar joint and blockage of the forearm rotation.
  
  
  OBJECTIVE
  The aim of this study is to evaluate the mid-term results of radial head excision with partial synovectomy in severe haemophilic patients retrospectively.
  
  
  METHODS
  Persistent pain and decreased forearm rotation were the main indications for radial head excision. Between 2002 and 2013, radial head excisions were performed for 14 elbows of 14 patients. Eleven patients were haemophilia A, whereas two patients were haemophilia B patients and the remaining one had von Willebrand (Type 3) disease. The mean age of the patients was 29 at the time of the surgery. The mean follow-up was 51 (12-155) months. VAS (visual analogue score) for pain, forearm rotation, qDASH and MEPS (Mayo Elbow Performance Score) were used as the primary outcome parameters.
  
  
  RESULTS
  The mean VAS decreased significantly from 6.5 preoperatively to 2.2 at the final follow-up (P = 0.0003). The mean forearm rotation increased from 40° to 115° respectively (P = 0.0007). In two patients, efficacious rotation increase was not achieved due to distal radioulnar joint problems. The mean qDASH score and MEPS were 18.1 and 87.5 at the latest follow-up, respectively, where four patients had excellent and 10 patients had good results.
  
  
  CONCLUSIONS
  Radial head excision is a safe and effective procedure for haemophiliac patients with radiocapitellar arthropathy and decreased forearm rotation. Distal radioulnar joint should be evaluated preoperatively which may impair the results.
authors.affiliation: Department Of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey.
authors.forename: A C
authors.initials: AC
authors.lastname: Atalar
authors.affiliation: Department Of Pediatric Haemotology and Oncology, Cerrahpasa Medical Faculty and Oncology Institute, Istanbul University, Cerrahpasa, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Koc
authors.affiliation: Department Of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Birisik
authors.affiliation: Department Of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Ersen
authors.affiliation: Department Of Pediatric Haemotology and Oncology, Cerrahpasa Medical Faculty and Oncology Institute, Istanbul University, Cerrahpasa, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Zulfïkar
mesh_terms: D000293:Adolescent; D000328:Adult; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006467:Hemophilia A / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011884:Radius / Q000503:physiopathology* / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D000074402:Synovectomy; D055815:Young Adult
keywords: elbow arthropathy; haemophilia; radial head excision