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Hemophilic arthropathy of the elbow
N Ishiguro1, S Yasuo, S Takamatu
1Department of Orthopaedic Surgery, Nagoya University School of Medicine, Japan.
Insights
Children with hemophilic arthropathy often experience restricted elbow movement due to recurrent bleeding. Radial head hypertrophy and altered bone growth are key factors contributing to these deformities in hemophilic joints.
Area of Science:
- Orthopedics
- Pediatrics
- Hematology
Background:
- Hemophilic arthropathy is a significant complication in children with hemophilia.
- Recurrent hemarthrosis leads to progressive joint damage and functional impairment.
Purpose of the Study:
- To characterize elbow joint changes in pediatric patients with hemophilic arthropathy.
- To identify factors associated with the development of elbow deformities in hemophilia.
Main Methods:
- Longitudinal follow-up of 32 pediatric patients (5-12 years) with hemophilia.
- Clinical assessment of elbow joint function, including range of motion.
- Radiographic evaluation of bone age and joint morphology.
Main Results:
- Forearm rotation and elbow extension limitations were common, linked to radial head hypertrophy.
- Advancement of bone age was observed in hemarthrotic elbows, correlating inversely with arthropathy severity.
- Differential growth between intraarticular and apophyseal cartilage was noted.
Conclusions:
- Recurrent hemarthrosis in hemophilic elbows causes characteristic deformities, primarily affecting rotation and extension.
- Radial head hypertrophy and altered bone maturation are critical in pediatric hemophilic elbow arthropathy.
- Discrepancies in epiphyseal and apophyseal cartilage growth may drive complex elbow deformities in hemophilia.
Abstract:
We investigated the characteristics of hemophilic arthropathy of the elbow joint in 32 patients 5-12 years of age who had been followed-up from infancy. Restriction of forearm rotation and elbow extension was the most common finding in the joints with recurrent hemarthrosis. Limitation of rotation resulted mainly from hypertrophy of the radial head. Advancement of bone age was also commonly observed in the joints with hemarthrosis. Mild to moderate hemophilic arthropathy was associated with greater advancement of bone age than was severe arthropathy. There was a discrepancy between the growth of the intraarticular subchondral epiphyseal cartilages and the cartilages of the medial and lateral epicondyles (apophyseal cartilage). This differential growth may be an important factor in the development of complicated and variable hemophilic elbow deformities.