Viscosupplementation in patients with hemophilic arthropathy.
OBJECTIVE
To assess whether viscosupplementation with hyaluronic acid in patients with severe hemophilic arthropathy associated with triamcinolone after washing with saline improves joint pain, stiffness, function and quality of life.


METHODS
Eleven patients with hemophilic arthritis of the knee with and without involvement of other joints (elbows and ankles) underwent joint lavage with saline and subsequent injection of Hylan and triamcinolone in all affected joints. The patients answered the algo-functional (Lequesne and WOMAC), visual analog scale for pain (VAS) and SF-36 (quality of life) questionnaires preoperatively, and at one and three months postoperatively.


RESULTS
Pain (VAS and WOMAC pain) and stiffness (WOMAC stiffness) did not show significant improvement (p = 0.3, p = 0.2, p = 0.1, respectively). However function had significant improvement given by WOMAC total and function (averaging 11 points, p = 0.04 and p = 0.001). There was no significant variation in scores in Lequesne's questionnaire (p = 0.1), yet both mental and physical components of SF-36 presented clinically relevant and significant improvements (p = 0.002).


CONCLUSIONS
Joint lavage with saline followed by injection of corticosteroids and Hylan is effective in the treatment of hemophilic arthropathy, especially in functional improvement and quality of life. Level of Evidence IV, Case series.
Institute of Orthopedics and Traumatology of Hospital das ClÃ nicas da Faculdade de Medicina da Universidade de São Paulo.
Flávio
F
Zelada
Institute of Orthopedics and Traumatology of Hospital das ClÃ nicas da Faculdade de Medicina da Universidade de São Paulo.
Adriano Marques
AM
de Almeida
Institute of Orthopedics and Traumatology of Hospital das ClÃ nicas da Faculdade de Medicina da Universidade de São Paulo.
Alexandre Felicio
AF
Pailo
Institute of Orthopedics and Traumatology of Hospital das ClÃ nicas da Faculdade de Medicina da Universidade de São Paulo.
Raul
R
Bolliger
Institute of Orthopedics and Traumatology of Hospital das ClÃ nicas da Faculdade de Medicina da Universidade de São Paulo.
Erica
E
Okazaki
Institute of Orthopedics and Traumatology of Hospital das ClÃ nicas da Faculdade de Medicina da Universidade de São Paulo.
Márcia Uchôa
MU
de Rezende
Hemophilia; Hyaluronic acid/ administration & dosage; Hyaluronic acid/therapeutic use; Knee; Osteoarthritis