The role of arthroscopic synovectomy in the management of hemarthrosis in hemophilia patients: financial perspectives

Abstract

Purpose: The purpose of this study was to determine the financial efficacy of arthroscopic synovectomy in hemophilia patients with recurrent hemarthroses.

Type of study: Cost-benefit analysis.

Methods: A retrospective chart review from 1993 through 1999 yielded 11 cases of arthroscopic synovectomies performed for recurrent hemarthroses at the University of Michigan. There were 7 ankle arthroscopies, 3 elbow arthroscopies, and 1 knee arthroscopy. The average age of the patients was 8 years (range, 4-13 years). All had the severe form of hemophilia A. The average follow-up was 41 months (range, 9-75 months). The preoperative costs were determined by multiplying the number of preoperative bleeds by the dollar amount of the replacement therapy used to treat the hemarthroses. The surgical costs included the surgery itself as well as the hospital stay and the dollar amount of the replacement therapy used in the perioperative period. The total postoperative costs included the surgical costs and the dollar amount of any replacement therapy used to treat any postoperative hemarthroses.

Results: The financial benefit of arthroscopic synovectomy was found to be statistically significant when average preoperative cost per month ($7,500) was compared with the average postoperative cost per month ($900), P =.028. Arthroscopic synovectomy was again found to be financially beneficial when the average total preoperative cost ($88,000) was compared with the average total postoperative cost ($24,000), P =.028. The average number of hemarthroses preoperatively was 71 and the average postoperatively was 7, which was statistically significant (P =.028).

Conclusions: In this small series of patients with intermediate follow-up, arthroscopic synovectomy was found to be cost effective in the treatment of patients with recurrent hemarthroses.