title: Subjective results of joint lavage and viscosupplementation in hemophilic arthropathy.
abstract: OBJECTIVE
  To assess whether joint lavage, viscosupplementation and triamcinolone improve joint pain, function and quality of life in patients with severe hemophilic arthropathy.
  
  
  METHODS
  Fourteen patients with knee and/or ankle hemophilic arthritis with and without involvement of other joints underwent joint lavage and subsequent injection of hylan G-F20 and triamcinolone in all affected joints. The patients answered algo-functional questionnaires (Lequesne and WOMAC), visual analog scale for pain (VAS) and SF-36 preoperatively, and at one, three, six and twelve months postoperatively.
  
  
  RESULTS
  Sixteen knees, 15 ankles, 8 elbows and one shoulder were treated in 14 patients. Six patients had musculoskeletal bleeding [ankle (1), leg muscle (2) and knees (4)] at 3 months affecting the results. Pain did not improve significantly. Function improved (WOMAC p=0.02 and Lequesne p=0.01). The physical component of SF-36 improved at all time points except at 3 months, with best results at one-year follow-up (baseline = 33.4; 1 month = 39.6; 3 months= 37.6; 6 months 39.6 and 1 year = 44.6; p < 0.001).
  
  
  CONCLUSIONS
  Joint lavage followed by injection of triamcinolone and hylan G-F20 improves function and quality of life progressively up to a year, even in severe hemophilic arthropathy. Level of Evidence IV, Case Series.
authors.affiliation: Department of Orthopedics and Traumatology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Márcia Uchoa
authors.initials: MU
authors.lastname: de Rezende
authors.affiliation: Department of Orthopedics and Traumatology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Thiago Bittencourt Carvalho
authors.initials: TB
authors.lastname: Rosa
authors.affiliation: Department of Orthopedics and Traumatology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Thiago
authors.initials: T
authors.lastname: Pasqualin
authors.affiliation: Department of Orthopedics and Traumatology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Renato
authors.initials: R
authors.lastname: Frucchi
authors.affiliation: Hematology Service, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Erica
authors.initials: E
authors.lastname: Okazaki
authors.affiliation: Hematology Service, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Paula Ribeiro
authors.initials: PR
authors.lastname: Villaça
keywords: Hemophilia; Hyaluronic acid/administration & dosage; Hyaluronic acid/therapeutic use; Osteoarthritis, knee