Hip Arthropathy in Haemophilia

Abstract

Hip arthropathy in haemophilic patients is disabling for hip and other common target joints. Even if bleedings in the hip are not frequent, femoroacetabular alterations may affect the functional ability of patients at a very young age. A haematologic prophylaxis combined with an adequate lifestyle and regular and low-traumatic physical activity are the keys to preventing such arthropathy. In the early stages of arthropathy, anti-inflammatory drugs and physical therapy may be sufficient to limit its progression. In cases of recurrent symptoms, viscosupplementation with hyaluronic acid, and chemical synoviorthesis are useful options. In more advanced stages, hip arthroscopy may be treated by synovectomy or loose body removal. For late stages, total hip arthroplasty (THA) is mandatory. Until a few decades ago, the clinical outcomes after hip arthroplasty were variable, due to the different management of patients and the use of old generation implants and couplings. In the last decade, the introduction of the multidisciplinary management and the use of modern cementless implants with high performing materials and less invasive surgical techniques have dramatically improved the functional results. Nowadays, as is the case for other target joints, the purpose of the management in haemophilia centers is the early detection of any hip alterations—by clinical and ultrasound (US) evaluations of patients in childhood—to reveal any early articular damage and to provide adequate treatment in case of symptoms. The present paper represents an updated review of the several approaches to hip arthropathy in haemophilia.

Musculoskeletal ultrasonography for arthropathy assessment in patients with hemophilia

“…The most commonly affected joints are the knee, elbow, and ankle joints, [3] but the shoulder, wrist, and hip joints can also be involved. [4]…”

Arthropathy in patients with hemophilia in the antananarivo hemophilia treatment center

“…Thus, our data are in good agreement with those of the literature. Similarly, Carulli and colleagues 23 reported a case of arthropathy in a severe, age-related hemophiliac A, aged 46, and this one in the hip. Djaroud and colleagues 24 also reported in 2011 11 cases of hemophiliacs including 4 cases of arthropathy in the shoulder.…”

Changes in Muscle Activity Patterns and Joint Kinematics During Gait in Hemophilic Arthropathy

“…In the hip joint, we observed a lower ROM in PWHA comparing to CG at the preferred velocity and lower flexion angle during the swing phase in PWHA comparing to CG at both velocities. It is not common in PWHA that the hip is affected by recurrent bleeding, and the hip is generally affected at a later stage (Carulli et al, 2017). Therefore, the lower hip flexion angle during the swing phase may be (partly) explained by changes of knee and ankle muscle activity and the reduced step length.…”