Changes of static and dynamic spine alignment in patients with severe haemophilia

Abstract

Introduction Haemophilic arthropathy results in a restricted range of motion and pain that often affects gait. The effect of these gait changes on spinal posture has not been studied. Aim To evaluate whether the altered joint situation in patients with haemophilia (PwH) leads to compensatory mechanisms evident in the trunk and spine, considering static and dynamic conditions. Methods PwH and healthy controls (20–65 years) were examined using rasterstereography in a controlled cohort study. Analysis was performed in static and dynamic conditions in regard to gait phases. Joint status was determined using the Haemophilia Joint Health Score (HJHS). Results Static measurements showed no group differences in PwH (n = 40) compared to healthy controls (n = 40) except pelvic torsion (median [25%‐quartile;75%‐quartile]: ‐1.9[‐3.2;.9]° vs. .5[‐1.1;1.9]°; P = .007). In contrast, under dynamic conditions PwH showed significantly higher trunk inclination and lower apex lumbar lordosis in all gait phases. Additionally, pelvic torsion was increased in mid stance and terminal swing. Considering joint status, PwH had a higher global HJHS (23.5[13.0;30.0] vs. 3.0[1.0;5.0]; P<.001). A significant moderate correlation was shown between the HJHS mobility score and spine parameters (r = .228–.588; P<.05). Conclusion Degenerative joint changes in PwH lead to altered spine posture during gait. A reason could be the reduced mobility in the affected joint. Changes in spinal and pelvic posture lead to higher structural burdens; therefore, clinicians should focus on posture of spinal column during gait in daily treatment.

Most subjectively affected joints in patients with haemophilia – what has changed after 20 years in Germany?

“…Haemorrhages in the joints and muscles in the lower extremities (e.g. ankle joint, knee joint or musculus iliopsoas) can alter posture in the entire musculoskeletal chain 14,25,26 . The consequences are extension and flexion deficits and joint instabilities, which affect the gait 11 .…”

“…ankle joint, knee joint or musculus iliopsoas) can alter posture in the entire musculoskeletal chain. 14,25,26 The consequences are extension and flexion deficits and joint instabilities, which affect the gait. 11 The additional reduction in physical activity and the change in muscular load distribution due to bleeding and pain leads to muscular imbalances and a decreased range of motion in the joint.…”

Postural Assessment Systems in the Prevention of Haemophilic Arthropathy: A Narrative Review

“…Hemarthrosis is very commonat the level of the synovial joints, in particular the knee and ankle, which are important for postural synergies [3]; if altered, they lead to alterations in postural balance and incorrect gaits, which often lead to the need for surgery [4][5][6][7]. This happens because repeated bleeding in haemophiliacs damages bone and ligament structures, altering information on joint mechanoreceptors, with a decrease in flexibility, strength, and proprioception [8,9].…”