[Conservative management of hemophilic arthropathy]

Intraarticular bleeding and muscle bleeding occur spontaneously or as a result of trauma in hemophilia A or B. The most common sites for hemarthrosis are the knees joints, elbows and ankles joints. Resorption of intraarticular blood induces reactive hemophilic synovitis Hyperplasia of the synovium can be followed by recurrent bleedings. These early reactions can change to a chronic synovitis and cause cartilage damage, finally resulting in a complete destruction of the joint. Since 1981 158 adults and 61 children with a hemophilia A or B were treated at the Center for hemophilic disorders Frankfurt in an interdisciplinary approach. Consequent prophylactic treatment with factor substitution can prevent the incidence of severe hemarthrosis. Minor joint bleedings are treated by adequate factor substitution, temporarily non-weight bearing of the extremity, application of ice-packs and physical therapy. More severe joint hemorrhages should be aspirated in order to reduce the acute synovitis. This is followed by a consequent physical therapy (joint and soft tissue techniques) and anti-inflammatory drugs. The goal is a sufficient muscular balance of the joint, the improvement of the coordination, and the proprioception. The chronic synovitis is less painful and poorly responses to conservative interventions. Local ice application, systemic and local anti-inflammatory treatment support the physical therapy. Soft heel shock absorber, elastic and semi-rigid bandages prevent recurrent bleeding episodes by shock absorption and decrease of synovial impingement. Synovectomy is indicated in cases of chronic persistent synovitis. Radiosynoviorthesis (RSO), which is an alternative in certain cases, has been performed with great success in 12 cases in our hospital. In advanced arthropathy joint mobilization should be the emphasis of the physical therapy. Bandages, crutches and ortopaedic shoe devices improve the walking capacity.