CHEMICAL SYNOVIORTHESIS

Abstract

In order to avoid recurrence of haemarthrosis in haemophilia, we must act on the syniovium membrane either resecting it (synovectomy) or fibrosing it (synoviorthesis). The intrarticular injection of Rifampicine (r) was introduce by us. Technique consists 250 mgrs. of Rifampicine injected intrarticularly in elbows and ankles and 500 mgrs. in knees with 3 to 10 cc of Lidocaine, depending on the joint size, once a week during five to seven weeks. Patients were only covered with antihaemophilic factor the day of the injection 30% above coagulation level. The evaluation was made by means of a double scale of grading. Subjective, given by the patient and objective by the examiner. Thus, objectively the grading was : EXCELLENT: “Dry joint”, recuperation of function. No haemarthrosis. No synovitis. GOOD: Clinical improvement. Synovitis. Diminution of haemarthrosis. Recuperation of function. FAIR: Synovitis. Diminution of haemarthrosis. No recuperation of function. BAD Synovitis. Recurrence of haemarthrosis. And subjectively the patient graded the results from his point of view from 1 BAD to 10 Excellent. 1,2,3 bad; 4,5,6 fair; 7 and 8 good and 9 and 10 excellent. We report on 38 patients with 39 joints with more that 3 years follow up, mean 1.8 years. on 22 knees, 9 elbows and 8 ankles with subjective excellent results in 21 joints (11 knees, 6 elbows and 4 ankles) good in 15 joints (8 knees, 3 elbows and 4 ankles), fair in 2 knees and bad in 1 knee. Objective results obtained were excellent in 20 joints (11 knees, 6 elbows and 3 ankles); good in 17 (9 knees, 3 elbows and 5 ankles); fair in 1 knee and bad in 1 knee. Since september 2000 we have been usisng OXITET-RACICLINE CLORHYDRATE named EMICINA(r) from PFIZER, comes in bottles with 20 and 100 cc of solution with a dose of 50 mg’s of active material per cc. of product. The dosage developed by us is in knees 4cc. (200mg) plus 6 cc anesthetic and for ankles 1 cc Emicina (50mg plus 1 cc anesthetic) once a week fot 3 weeks. Our experience consists in 43 joints, 21 knees 14 elbows and 8 ankles. All joints Stage I or II of our classification. Evaluation was made according to objective and subjective scale: Pain from 0 (no pain) to 10 (pain requiring medication), Range of Movement: No movement (0) to complete range of movement 10, use of limb from 0 (impossibility to weight bear) to 10 normal use in daily activities. Objective evaluation was made by measuring ROM and diameter of joint. All cases had very satisfactory results with diminution of swelling, absence of haemarthrosis and improvement of ROM and activity of daily life. Subjewctively pain diminished a mean 0.5 (Liker), movility improved 9.0 mean, and the use improved a mean of 9.3. Objectively the mean joint diameter diminished from 31.5 cmts to 30.2 cmts and ROM improved from 102.4 and 158.8 degrees pre to 112.2 and 166.7 post.