Intra-articular injections of hyaluronic acid induce positive clinical effects in knees of patients affected by haemophilic arthropathy.
BACKGROUND
Haemophilic arthropathy is the most common clinical manifestation of haemophilia, secondary to recurrent haemarthrosis and chronic synovitis, and the knee represents the main target joint. Modern bleeding prevention has significatively limited the incidence of severe arthropathy, and primary approach is usually conservative. Viscosupplementation is felt as one of the most efficient treatments for the early stages of knee haemophilic arthropathy, based on short-term follow-up studies. The aim of this prospective case series study is to assess the clinical effectiveness of intra-articular administration of hyaluronic acid in the knee, evaluating long-term results, and focusing on the necessity of further treatments after viscosupplementation.


METHODS
Twenty-seven haemophilic patients with knee arthropathy underwent at least two cycles of injections of hyaluronians between 2003 and 2009. They were evaluated with VAS, SF-36, WFH, Pettersson score, and WOMAC, with a seven-year follow-up.


RESULTS
All patients showed improvement in pain relief and functional recovery without any complications. Considering the severity of arthropathy in haemophilic patients, only a limited number of subjects (five) underwent total knee arthroplasty for persistent pain or functional limitation.


CONCLUSIONS
Viscosupplementation is a safe and effective therapeutic strategy in knee haemophilic arthropathy, with no complications, persisting good clinical results, and determining in most cases a delay of surgery.
First Orthopaedic Clinic, University of Florence, Florence, Italy. christian.carulli@unifi.it
Christian
C
Carulli
Fabrizio
F
Matassi
Roberto
R
Civinini
Massimo
M
Morfini
Massimiliano
M
Tani
Massimo
M
Innocenti
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000188:drug therapy* / Q000503:physiopathology; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D013997:Time Factors; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage; D055815:Young Adult
D055675:Viscosupplements; D006820:Hyaluronic Acid