Subchondral haematoma. The missing link in understanding haemophilic arthropathy?
Haemophilic arthropathy is a complex multifactorial disorder that poses significant challenges to both the treating haematologist and arthroplasty surgeon. Its pathogenesis is incompletely understood. Recent literature has concentrated on the toxic effects of iron and the characteristic inflammatory synovitis. Discussion of the role of subchondral bleeding in joint damage has been neglected. A case of haemophilic arthropathy with extensive evidence of subchondral bleeding and related osteochondral destruction is presented.


RESULTS
The relevance of this mechanical pathway in the future management of haemophilic arthropathy is discussed with reference to recent literature.


CONCLUSIONS
Clinicians should consider its importance when deciding whether to manage patients expectantly or with prophylactic factor replacement.
Rupert Wharton, BM, BSc, Department of Trauma and Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK, Tel. +44/20/71 88-71 88, Fax -44 47, E-mail: rupertwharton@hotmail.co.uk.
Rupert
R
Wharton
Steve
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Austin
Diane
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Back
D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D003937:Diagnosis, Differential; D006395:Hemarthrosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome
Arthritis; arthroplasty; haemarthrosis; haemophilia; pathophysiology; subchondral bleed