Morphological analysis of patellofemoral joint in haemophilic arthropathy: A case‐control study

Abstract

IntroductionKnees affected by haemophilic arthropathy exhibit distinct differences in both bone morphology and soft tissue behaviour. This study aims to analyse the morphological characteristics of the distal femur and patellofemoral joint in patients with haemophilia in comparison to normal healthy population.Material and MethodsStudy was conducted as pair‐matched case‐control study with 43 individuals in both the haemophilia group and the control group. Patellar luxation, patellar tilt (PT), length of the patella in both axis (pAP, pML), depth and angle of trochlear sulcus (SD, SA), lateral trochlear inclination (LTI), medial and lateral femoral facet length (mFL, LFL), intercondylar depth (ID), transepicondylar axis (TEA) and lateral condyle length (LCL) were assessed on knee MRI. Correlation between Pettersson score and measured variables were also analysed.ResultsPT was medial sided in 10 (23.2%) cases in haemophilic group. Mean values of pAP, pML, PT were significantly lower in haemophilia group (p < .001, p: .007, p = .001 respectively). There were no significant changes in SA (p = .628), SD (p = .340), LTI (p = .685), LFL (p = .241) and MFC‐LFC (p = .770) whilst mFL was significantly longer in haemophilia group (p = .009). ID (p < .001), TEA (p = .007) and LCL (p = .001) were all shorter in haemophilia group. Pettersson score was inversely correlated with pAP, pML, ID, TEA, LCL, pML/SA and ID/LCL.ConclusionMorphological changes in haemophilic arthropathy involve a smaller and medially‐tilted patella, narrowed lateral condyle and transepicondylar axis, combined with reduced intercondylar depth. These alterations must keep in mind especially in pre‐ and intraoperative assessments for arthroplasty procedures.

Accuracy and clinical role of digital templating for total knee arthroplasty performed on haemophilic knees

“…18,19 It is marked by stiff and deformed knees with osteoporotic bones. [20][21][22][23] In cases of advanced haemophilic arthropathy, total knee arthroplasty is recognized as the gold standard treatment, which requires careful preoperative planning as it is often a challenging procedure. Haemophilic knees differ notably from primary osteoarthritis, exhibiting enlarged epiphyses, increased tibial slope, altered patellofemoral joint anatomy, and alterations in femoral condyle and notch morphology.…”