Conservative treatment measures in hemophilic arthropathy

Intraarticular bleeding and muscle bleeding occur spontaneously or as a res ult of trauma in hemophilia A or B. The most common sites for hemarthrosis are the knees joints, elbows and ankles joints. Resorption of intraarticula r 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 com plete 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 Fra nkfurt in an interdisciplinary approach. Consequent prophylactic treat ment with factor substitution can prevent the incidence of severe hemarthrosis. Minor joint bleedings are treated by adequate factor substitution, tempora rily non-weight bearing of the extremity, application of ice-packs and phys ical therapy. More severe joint hemorrhages should be aspirated in order to reduce the acute synovitis. This is followed by a consequent physical ther apy (joint and soft tissue techniques) and anti-inflammatory drugs. The goa l is a sufficient muscular balance of the joint, the improvement of the coo rdination, and the proprioception. The chronic synovitis is less painful an d poorly responses to conservative interventions. local ice application, sy temic and local anti-inflammatory treatment support the physical therapy. S oft 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. Radiosy noviorthesis (RSO), which is an alternative in certain cases, has been perf ormed with great success in 12 cases in our hospital. In advanced arthropat hy joint mobilization should be the emphasis of the physical therapy. Banda ges, crutches and ortopaedic shoe devices improve the walking capacity.