Presentation
Chronic knee pain, known case of hemophilia.
Patient Data
Tricompartmental osteoarthritic changes are seen as a significant reduction of joint space, osteophytes formation, and subchondral cyst formation, changes are more pronounced in the medial tibiofemoral compartment. Subtle periarticular osteopenia was noted in addition to a widened intercondylar notch and flattened condylar surfaces more in the lateral side.
Normal alignment of the knee joint, no evidence of dislocation or bony fracture. No significant soft tissue swelling or joint effusion was noted.
Radiological features of hemophilic arthropathy (Arnold-Hillgartner classification stage IV).
Case Discussion
Hemophilia leads to recurrent bleeding episodes in joints resulting in a severe destructive arthropathy in many cases. Staging of hemophilic joint disease is important for identifying the site of bleeding and planning appropriate therapy.
However, classification systems based on plain X-ray findings have been insensitive at detecting the earlier, possibly reversible, changes of synovial hyperplasia. They may also underestimate the severity of cartilage damage. Magnetic resonance imaging has been shown to assess a hemophilic joint more accurately.
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