Hemophilic arthropathy. Current concepts of pathogenesis and management

Arnold, W; Hilgartner, M. W.

doi:10.2106/00004623-197759030-00001

Cited by 554 publications

(387 citation statements)

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“…The average amount of factor required to control bleeding episodes was 4,633 U (range 750-14,000 U). Radiographic staging was based on the classification of Arnold and Hilgartner [2]. In stage I, there are no skeletal abnormalities, only soft-tissue swelling about the joint.…”

Section: Methodsmentioning

confidence: 99%

Arthroscopic synovectomy in haemophilic arthropathy of the knee

Yoon

Bae

Kim

et al. 2005

International Orthopaedics (SICOT)

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From January 1996 to January 2001, arthroscopic synovectomies were performed in 28 knees with haemophilic arthropathy. The mean follow-up period was 5 years and 11 months. Six portals (two anterior, two suprapatellar, two posterior) and a posterior trans-septal portal were used in all cases. The average Hospital for Special Surgery (HSS) knee score increased from 56.4 to 71.5 points at the last follow-up. The average frequency of haemarthrosis reduced from five times per month before operation to once per month. The amount of factor replacement decreased from a mean of 4,633 U to 1,505 U. Progression of arthritis was observed radiographically in three cases at the last follow-up. An arthroscopic synovectomy of the knee using appropriate arthroscopic portals is a useful method in treating haemophilic patients as it decreases bleeding episodes, amount of factor replacement and knee pain.Résumé De janvier 1996 à janvier 2001, des synovectomies arthroscopiques ont été exécutées dans 28 genoux avec une arthropathie hémophilique. Le suivi moyen était 5 années et 11 mois. Six abords (deux antérieurs, deux suprarotuliens, deux postérieurs) et un abord trans-septal postér-ieur ont été utilisé dans tous les cas. Le score moyen du genou de l'Hôpital pour Chirurgie Spéciale (HSS) a augmenté de 56,4 à 71,5 points au dernier examen. La fré-quence moyenne d'hémarthrose s'est réduite de cinq fois par mois avant l'opération à une fois par mois aprés. La quantité moyenne de remplacement de facteur a diminué de 4,633 à 1,505 unités. Dans l'évaluation radiographique, la progression de l'arthrite a été observée dans trois cas au dernier suivi. Une synovectomie arthroscopique du genou qui utilise des abords arthroscopiques appropriés est une méthode utile pour traiter les malades hémophiliques, diminuant les épisodes de saignement, la quantité de facteur et les douleurs du genou.

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Section: Methodsmentioning

confidence: 99%

Arthroscopic synovectomy in haemophilic arthropathy of the knee

Yoon

Bae

Kim

et al. 2005

International Orthopaedics (SICOT)

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“…Nevertheless, this imaging modality is only able to diagnose late arthropathic changes, most notably subchondral and bony abnormalities. While the World Federation of Hemophilia Pettersson X-ray scale [13] does not contain an item to represent soft tissue changes, the Arnold-Hilgartner X-ray scale [14] grades soft tissue and osteochondral changes subjectively on a 0-5 grading system. Pathological changes such as synovial hypertrophy, joint effusion, hemosiderin deposits and periarticular oedema can appear as nonspecific soft tissue swelling on radiography.…”

Section: Radiographymentioning

confidence: 99%

State‐of‐the‐art imaging techniques for the evaluation of haemophilic arthropathy: present and future

Doria

2010

Haemophilia

102

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Summary. In spite of the fact that the diagnosis of haemophilia is essentially clinical and laboratorybased, imaging has become an important tool for the evaluation of complications, diagnostic confirmation and/or complementation and therapeutic follow-up in haemophilic arthropathy. Radiography remains the workforce horse in the diagnosis and follow-up of haemophilic arthropathy. The radiographical findings in arthropathy follow an expected sequence of events and are overall similar in different joints. Magnetic resonance imaging (MRI) has advantages over radiography based on its capability of visualizing soft tissue and cartilage changes in haemophilic joints. The recent development and standardization of MRI scoring systems for measuring soft tissue and cartilage abnormalities may enable the comparison of pathological joint findings in clinical trials conducted at different institutions across the world. The implementation of high-frequency transducers and colour/power Doppler capabilities has provided new insights for clinical applications of ultrasonography (US) in haemophilic arthropathy. In spite of the imaging modality's technical challenges such as operator-dependency, US has advantages over MRI. One of these advantages is its ability of differentiating synovium hypertrophy and hemosiderin deposition, which is not possible with MRI given the presence of susceptibility artefacts from extracellular hemosiderin on gradient-echo MR images. In addition to the aforementioned conventional imaging modalities, novel imaging techniques (blood oxygen level dependent, ultrasmall superparamagnetic ironoxide contrast-enhanced, and T1 and T2 mapping MRI, ultrasound biomicroscopy, microbubble contrast-enhanced US and positron emission tomography, among others) hold promise for early assessment of haemophilic arthropathy in the future upon completion of their clinical validation.

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“…The pre-operative median Petrini score was 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)). The youngest patients had the best clinical status (q = 0.66, P \ 0.001).…”

Section: Resultsmentioning

confidence: 99%

Surgical synovectomy of the knee in young haemophiliacs: Long-term results of a monocentric series of 23 patients

Rampal

Odent

Torchet

et al. 2010

Journal of Children's Orthopaedics

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Background In haemophiliacs, synovectomy is indicated for recurrent joint bleedings, despite medical treatment. Method We report a series of 23 surgical synovectomies of the knee with a median follow-up of 8.8 years. The median age of patients at surgery was 13.5 years. Clinical and radiological evaluations were made according to the Petrini and the Pettersson scores, at 1 and 5 years after surgery, and at the last follow-up. Wilcoxon and Spearman's tests were used for the statistical analysis. Result The Petrini score improved at 1 and 5 years (P \ 0.001). Nine patients have 20 years of follow-up and a stable result. In more than half of the knees, no episode of recurrent bleeding occurred. The effect of surgery on the range of motion (ROM) was moderate and mobilisation under anaesthesia did not improve it significantly. There was a progressive worsening of the radiological score, but no correlation between clinical and radiological score was noticed (q = 0.08, P = 0.77). Conclusion Complete synovectomy gives good long-term results in term of bleeding recurrence and overall function.

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Hemophilic arthropathy. Current concepts of pathogenesis and management

Cited by 554 publications

References 0 publications

Arthroscopic synovectomy in haemophilic arthropathy of the knee

Arthroscopic synovectomy in haemophilic arthropathy of the knee

State‐of‐the‐art imaging techniques for the evaluation of haemophilic arthropathy: present and future

Surgical synovectomy of the knee in young haemophiliacs: Long-term results of a monocentric series of 23 patients

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