title: Joint lavage followed by viscosupplementation and triamcinolone in patients with severe haemophilic arthropathy: objective functional results.
abstract: BACKGROUND
  Viscosupplementation can improve function in haemophilia patients. Viscosupplementation results can be improved by prior joint lavage and triamcinolone administration.
  
  
  OBJECTIVE
  To objectively assess whether viscosupplementation and associated triamcinolone use in patients with severe haemophilic arthropathy following joint lavage improves force and balance and reduces bleeding events.
  
  
  METHODS
  Fourteen patients with haemophilic knee arthritis with and without the involvement of other joints underwent joint lavage and subsequent injections of Hylan G-F20 and triamcinolone into all affected joints. Patients were evaluated with NeuroCom®force and balance platforms using the step-up-and-over task (STP), sit-to-stand test (STS), one-leg stance (UNI) and weight-bearing squat (WBS) at baseline and at 1, 3, 6 and 12 months after the procedure. Bleeding events in the year prior to and the year after the procedure were analysed.
  
  
  RESULTS
  Sixteen knees, 15 ankles, eight elbows and one shoulder were treated. The STP results indicated improvements in the lift-up indices (right leg) at all time points evaluated (P = 0.03). The STS results revealed coupled improvement in weight transfer and the rising index for up to a year (P = 0.02). Balance (UNI) with eyes open or closed improved in all evaluations. The WBS results revealed improvements at all degrees of flexion (0, P = 0.003; 30°, P = 0.001; 60°, P < 0.001 and 90°, P < 0.001). The numbers of total and traumatic bleeding events were reduced (P = 0.04).
  
  
  CONCLUSIONS
  Joint lavage followed by injections of triamcinolone and Hylan G-F20 improved balance, function and bleeding events in severe haemophilic arthropathy patients.
authors.affiliation: Orthopedics and Traumatology Institute, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: M U
authors.initials: MU
authors.lastname: Rezende
authors.affiliation: Orthopedics and Traumatology Institute, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: F R
authors.initials: FR
authors.lastname: Andrusaitis
authors.affiliation: Orthopedics and Traumatology Institute, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: R T
authors.initials: RT
authors.lastname: Silva
authors.affiliation: Hematology Clinic, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Okazaki
authors.affiliation: Hematology Clinic, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: J D A
authors.initials: JD
authors.lastname: Carneiro
authors.affiliation: Orthopedics and Traumatology Institute, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: G C
authors.initials: GC
authors.lastname: Campos
authors.affiliation: Orthopedics and Traumatology Institute, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: A F
authors.initials: AF
authors.lastname: Pailo
authors.affiliation: Orthopedics and Traumatology Institute, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Frucchi
authors.affiliation: Orthopedics and Traumatology Institute, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: T
authors.initials: T
authors.lastname: Pasqualin
authors.affiliation: Hematology Clinic, Medical School University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: P R
authors.initials: PR
authors.lastname: Villaça
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006395:Hemarthrosis / Q000150:complications*; D006467:Hemophilia A / Q000188:drug therapy*; D006801:Humans; D008297:Male; D014221:Triamcinolone / Q000008:administration & dosage / Q000627:therapeutic use*; D055676:Viscosupplementation / Q000379:methods*; D055815:Young Adult
chemical_list: D014221:Triamcinolone
keywords: hemophilia; hyaluronic acid/administration & dosage; hyaluronic acid/therapeutic; knee; osteoarthritis