Clinical relevance of 3D gait analysis in patients with haemophilia

Abstract

Haemophilia is characterized by a congenital deficiency of clotting factor VIII or IX. One of the consequences of haemophilia is joint bleedings. Repetitive haemathroses induce cartilage damage and chronic synovitis leading to joint deterioration, and to definitive haemophilic arthropathy which is source of walking disability. Three-dimension gait analysis (3DGA) appears particularly relevant in the case of haemophilia because it allows an evaluation of several joints in weight-bearing situations. The purpose of this study was to review the interest and the contribution of 3DGA in the management of patients with haemophilia. The greatest interest of gait analysis would be to detect early walking changes with a non-invasive and well-tolerated examination, especially in paediatric population. In adulthood, this technic may be also useful to help detect walking worsening in patients known to have already arthropathy. However, it takes time to realize and needs expensive equipment, which limits its possibility of routine use. Although generalizations of these results remain difficult, especially to compare patients with haemophilia to normal population. Indeed, in the studies, patient groups are small and usually heterogeneous in terms of age and target joints. It certainly results of the rarity of the disease. So, it could be interesting to perform a study with a larger cohort in order to allow subgroup analysis, helping to define clearly the place of 3DGA in the strategy of haemophilia evaluation.

Isokinetic knee strength deficit in patients with moderate haemophilia

“…However, it could be interesting to perform new studies to evaluate the impact of our findings on daily function, especially on walking. Three‐dimensions gait analysis may be interesting in this perspective as it appears relevant in the evaluation of patients with haemophilia 44 …”

The Progression of Hemophilic Arthropathy: The Role of Biomarkers

“…Gait analysis is a well-established tool for the quantitative assessment of gait disturbances providing functional diagnosis, assessment for treatment planning and monitoring of disease progress [ 13 ]. As highlighted in a recent review [ 14 ], gait analysis is a promising tool to detect early walking changes with a non-invasive and well-tolerated examination especially in the pediatric population [ 15 , 16 , 17 , 18 , 19 , 20 ]. In adulthood, this technique may be also useful to help detect walking worsening in patients with a known diagnosis of arthropathy [ 21 , 22 , 23 ].…”

“…Early alterations in muscle function remain often undetected because the clinical scores usually adopted to examine joint status in patients with hemophilia are able to detect late function impairment when flexion contracture, shortening, weakening or atrophy become evident and rehabilitation is more difficult [ 14 , 15 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

Clinical gait features are associated with MRI findings in patients with haemophilic ankle arthropathy

“…[14][15][16] These kinetic parameters are considered to be surrogate measures to evaluate how subjects modify their gait features to cope with the mechanical loading on joints during walking. 17 The aim of this paper therefore was to investigate the association between blood-induced ankle joint damage and kinetic parameters of the ankle joint in adult PwH. Our hypothesis was to find a negative association between the IPSG-MRI score and kinetic variables in adult patients with haemophilic ankle arthropathy.…”

“…To further analyse the ankle joint function, recent progresses were achieved by developing multi‐segment kinetic foot models, which better grasp the complex function of the ankle and foot joints during walking by analysing kinetic parameters . These kinetic parameters are considered to be surrogate measures to evaluate how subjects modify their gait features to cope with the mechanical loading on joints during walking …”