Haemophilic elbow arthropathy treated with therapeutic arthroscopy - A haemophilia tertiary centre experience.

Abstract

Elbow arthroscopy is a treatment option for advanced symptomatic arthropathy with few outcomes reported in the literature. This study determines the safety and short to long-term outcome of therapeutic elbow arthroscopy in haemophilic arthropathy of the elbow. Patients undergoing arthroscopy between 2005 and 2023 were included. Patients were treated by a multidisciplinary team comprising orthopaedic surgeon, haematologists, physiotherapists and allied professionals. All patients were assessed pre-operatively, intra-operatively and post-operatively with pain, range of motion (ROM), Haemophilia Joint Health Score (HJHS) and EQ5D. Fifteen elbows in 13 patients were managed with arthroscopy for symptomatic haemophilic arthropathy. Mean age was 44.1 ± 13.1 years. The median follow-up was seven years. Intra-operatively, flexion-extension and prono-supination improved by 35° and 26°, respectively. This gradually deteriorated with time, returning to pre-operative levels at approximately 2-5 years. HJHS improved by 2.5 points at six months, 1.67 at 12 months and returned to pre-operative levels at 2-5 years. EQ-VAS score deteriorated by 10.5 points at six months but improved by 19.1 at 12 months, by 10.1 at 2 years and by 14.4 at five years. There were no perioperative complications, the commonest complication was recurrence of stiffness, and two required arthroplasty in long term. Therapeutic arthroscopy is safe in advanced haemophilic elbow arthropathy. It shows potential benefit for function and quality of life in the short to medium term. Though there is a 33% risk of further surgery within 10 years, it should be considered an important adjunct to the multidisciplinary musculoskeletal care pathway in haemophilic elbow arthropathy, especially amongst a young patient cohort.