Konservative Behandlungsmaßnahmen der hämophilen Arthropathie

Abstract

Intraarticular bleeding and muscle bleeding occur spontaneously or as a result of trauma in hemophilia A or B. The most common sites for hemarthrosis are the knees joints, elbows and ankles joints. Resorption of intraarticular blood induces reactive hemophilic synovitis Hyperplasia of the synovium can be followed by recurrent bleedings. These early reactions can change to a chronic synovitis and cause cartilage damage, finally resulting in a complete destruction of the joint. Since 1981 158 adults and 61 children with a hemophilia A or B were treated at the Center for hemophilic disorders Frankfurt in an interdisciplinary approach. Consequent prophylactic treatment with factor substitution can prevent the incidence of severe hemarthrosis. Minor joint bleedings are treated by adequate factor substitution, temporarily non-weight bearing of the extremity, application of ice-packs and physical therapy. More severe joint hemorrhages should be aspirated in order to reduce the acute synovitis. This is followed by a consequent physical therapy (joint and soft tissue techniques) and anti-inflammatory drugs. The goal is a sufficient muscular balance of the joint, the improvement of the coordination, and the proprioception. The chronic synovitis is less painful and poorly responses to conservative interventions. Local ice application, systemic and local anti-inflammatory treatment support the physical therapy. Soft heel shock absorber, elastic and semi-rigid bandages prevent recurrent bleeding episodes by shock absorption and decrease of synovial impingement. Synovectomy is indicated in cases of chronic persistent synovitis. Radiosynoviorthesis (RSO), which is an alternative in certain cases, has been performed with great success in 12 cases in our hospital. In advanced arthropathy joint mobilization should be the emphasis of the physical therapy. Bandages, crutches and ortopaedic shoe devices improve the walking capacity.

Flexionskontraktur bei hämophiler Kniearthropathie - 10-Jahres-Follow-up nach Hamstring-Release und dorsaler Kapsulotomie

“…Im Mittelpunkt der konservativen Behandlung stehen intensive physiotherapeutische Dehn-und Bewegungsübungen zur Lö-sung der Beugekontraktur und Verbesserung der Kniegelenksbeweglichkeit, ggf. erfolgt zusätzlich eine temporäre Orthesenversorgung [7]. Bei konservativ therapieresistenten oder fortgeschrittenen Kniegelenkskontrakturen sollten zur Verhinderung einer Progredienz mit weiterer Einschränkung der Mobilität operative Maßnahmen erwogen werden.…”

Knieendoprothetik bei hämophiler Arthropathie: Ergebnisse, Probleme und Komplikationen

“…Diese hämorrhagisch-entzündliche Form der chronischen Synovitis geht später in eine villös-hypertrophe Form über [3] In allen Stadien der hämophilen Arthropathie stehen konservative medikamentös-physikalische Behandlungsmaûnahmen in Kombination mit einer Substitution der Gerinnungsfaktoren im Vordergrund [4]. Die Indikation zu operativen Maûnahmen sollte beim Bluter grundsätzlich nur in Absprache mit dem Hämostaseologen gestellt werden.…”