Exercise and Nutrition Treating Joint Damage1
For people with hemophilia, repeated bleeding episodes in the same joint can cause the synovial membrane surrounding the joint to thicken and become inflamed. As a result, the synovial fluid no longer lubricates the joint's cartilage.
This condition, called synovitis, causes problems ranging from pain and loss of motion to crippling arthritis.
For some people with hemophilia, a procedure called a synovectomy is helpful. With a synovectomy, excess synovial tissue is removed. A thin layer of healthy synovium grows back after the procedure, and the joint often experiences fewer bleeds.
A synovectomy may be done in one of three ways.
In this procedure, radioactive material called 32P (Phosphorus 32) is injected into the joint. The low levels of radiation emitted by the 32P slow growth of new synovial cells that would cause more thickening.
Following this outpatient procedure, patients go home with a splint or cast.
With arthroscopic synovectomy, a small metal tube is inserted through 2 or 3 very small incisions in the joint. The excess synovial membrane is removed through this tube.
This procedure may be effective in reducing the number of bleeds and maintaining or improving range of motion in the joint.
Because the joint is not opened, recovery time is shorter than with open surgery. However, removal of all the excess synovial tissue is more difficult through the tube than with open surgery.
In open synovectomy, the joint is surgically opened through an incision. This allows clear access to the joint so all the damaged tissue can be found and removed.
Because of the incision and the fact that the actual joint capsule is opened, there is a longer recovery time. Some loss of motion may also occur with open synovectomy.
Which type of synovectomy would be best for you? Consult with your treatment center, physician, and orthopedic surgeon.
Sometimes damage to a joint is so severe that infusions of factor and synovectomies are no longer options. In these cases, orthopedic surgery may be the best choice to provide relief and improve movement.
Arthrodesis, or fusion, is used to control pain and bleeding, particularly in the ankles. Arthrodesis uses staples, screws, or even bone grafting to ensure that the joint fuses correctly. Many patients are able to hike or bike for miles after this procedure.
Total Joint Replacement
Total joint replacement is a surgery in which the joint is removed and replaced with an artificial joint made of metal, ceramic, or plastic called a prosthesis. Large joints such as the knee, hip, or shoulder are the best candidates for this procedure.
The key to success with any of these procedures is good follow-up care. This means a commitment to regular factor treatment following the operation and a regimen of physical therapy.
Note: ThereForYou.com does not recommend a particular treatment for specific individuals and recommends that you consult your treatment center or physician before pursuing any course of treatment.
- Geraghty S, Dunkley T, Harrington C, Lindvall K, Maahs, Sek J. Practice patterns in haemophilia A therapy – global progress towards optimal care. Haemophilia (2006), 12, 75-81.