Five stages of joint disintegration compared with range of motion in hemophilia

The Arnold-Hilgartner roentgenographic method, categorizing hemophilic arthropathy into five stages, was evaluated in 270 hemophilic joints in terms of range of motion. The early stages, 0 or normal, Stage 1, and Stage 2, were associated with a 90% of normal or greater range of motion in the elbow, knee, and ankle, the three joints most commonly affected and studied here. These stages also showed the greatest variation between double-blind staging. The elbow showed the greatest degree of degeneration with the least loss of range of motion, whereas just the opposite was true for the ankle with the knee intermediate. With advanced arthropathy the mean arc for the elbow at Stage 3 was 127 degrees, Stage 4 was 100 degrees, and Stage 5 was 78 degrees. For the knee, Stage 3 was 121 degrees, Stage 4 was 95 degrees and Stage 5 was 47 degrees. For the ankle Stage 3 was 55 degrees, Stage 4 was 44 degrees, and Stage 5 was 22 degrees. The early loss with no exceptions was extension of the elbow, flexion of the knee, and dorsiflexion of the ankle. Loss of cartilage joint space was the most important roentgenographic finding related to range of motion.