Anatomical bone structure differences in patients with hemophilic arthropathy of the knee

Abstract

Objectives: The anatomical differences of the bony structure of the knee joint in patients with hemophilia were evaluated, and the results were compared with the knees of patients with primary gonarthrosis and no arthrosis. Material and Methods: This study reviewed 41 knees in 21 patients (with an Arnold-Hilgartner classification of Stages 4 and 5 hemophilic arthropathy) who underwent total knee arthroplasty in single center. Two control groups including 21 asymptomatic patients (42 knees) and 21 primary knee osteoarthritis patients (42 knees) were formed to compare the measurements with hemophiliacs. Femoral mediolateral width, femoral anteroposterior width, femur and tibia diaphysis width, adductor tubercle-joint line distance, tibial plateau width, and medial and lateral tibia plateau width were measured separately. Results: Femoral mediolateral width was significantly narrow comparing with healthy individuals and primary knee osteoarthritis group. Tibial plateau was similar to asymptomatic group but significantly narrow compared with primary knee osteoarthritis group. With the correlation, the tibial plateau measurements and medial and lateral plateau were significantly narrow at hemophilic arthropathy group (P < 0.05). The slope was less in hemophilic patients as compared with asymptomatic individuals (P: 0.001). Hemophilic patients had larger femoral aspect ratios than asymptomatic group but there were no observable differences with the primary osteoarthritis group. For the tibial aspect ratios, hemophilic had a smaller ratio than the primary osteoarthritis group but there were no significant differences with the asymptomatic group. Conclusion: Hemophilic knee has a mismatch between femoral and tibial side while comparing with the other groups. Level of Evidence: Level IV, cross-sectional study.

Morphological analysis of patellofemoral joint in haemophilic arthropathy: A case‐control study

“…These reports indicate that the medial posterior condyle is narrower, and the intercondylar notch is larger in comparison to knees affected by osteoarthritis 10 . Furthermore, mediolateral width of the femur in haemophilic knees is reduced compared to both healthy individuals and those with osteoarthritis 12 …”

“…Preoperative recognition of these challenges aids surgeons in technical execution and optimal implant selection. [9][10][11][12][13] Patellofemoral morphological characteristics have been extensively studied in conditions such as patellar instability, patellofemoral arthrosis, and patellofemoral pain and several variables linked with corresponding pathologies. [14][15][16][17] Several reports have highlighted distinctive anatomical features in haemophilic knees.…”

“…10 Furthermore, mediolateral width of the femur in haemophilic knees is reduced compared to both healthy individuals and those with osteoarthritis. 12 However, a comprehensive assessment of morphological changes associated with the patellofemoral joint in knees affected by haemophilic arthropathy has not been reported before. This study aims to thoroughly analyse the morphological characteristics of the distal femur and patellofemoral joint in PwHs in comparison to normal healthy population.…”

“…The substantial morphological distinctions between haemophilic arthropathic knees and primary osteoarthritic knees pose distinct differences in total knee replacement surgeries. Preoperative recognition of these challenges aids surgeons in technical execution and optimal implant selection 9–13 …”

Accuracy and clinical role of digital templating for total knee arthroplasty performed on haemophilic knees

“…Haemophilic knees differ notably from primary osteoarthritis, exhibiting enlarged epiphyses, increased tibial slope, altered patellofemoral joint anatomy, and alterations in femoral condyle and notch morphology. 21,24 There is a notable absence of studies examining the accuracy of 2D digital templating applications on haemophilic knees. Additionally, the clinical role of data derived from 2D templating in haemophilic cases remains unknown.…”