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HSS Journal ®

, Volume 14, Issue 3, pp 307–313 | Cite as

Point-of-care Ultrasonography in Orthopedic Management of Hemophilia: Multiple Uses of an Effective Tool

  • Hortensia De la Corte-Rodriguez
  • E. Carlos Rodriguez-MerchanEmail author
  • Víctor Jimenez-Yuste
Review Article

Abstract

Even in our current era of hemophilia prophylaxis, articular complications can arise and there is a growing need for strategies in the prevention, diagnosis, and treatment of hemophilic arthropathy, a significant contributor to disability in patients with hemophilia. One useful tool, point-of-care ultrasonography (POC-US), offers diverse diagnostic and therapeutic possibilities. This article reviews the literature on the uses of POC-US in hemophilia, including early diagnosis of joint damage, differential diagnosis of articular pain, follow-up of joint injury, and guidance for both arthrocentesis and intra-articular injection. Studies show that for patients with hemophilia, POC-US enhances diagnostic accuracy and targeted treatments. Further research is required into the most efficient use of POC-US and the training needed to develop clinicians’ skills. The attributes of POC-US should be understood more fully to enable its widespread application.

Keywords

hemophilia ultrasonography point-of-care arthropathy 

Notes

Compliance with Ethical Standards

Conflict of Interest

Hortensia De la Corte-Rodriguez, MD, PhD; E. Carlos Rodriguez-Merchan, MD, PhD; and Víctor Jimenez-Yuste, MD, PhD, declare that they have no conflicts of interest.

Human/Animal Rights

N/A

Informed Consent

N/A

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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References

  1. 1.
    Acharya SS, Rule B, McMillan O, Humphries TJ. Point-of-care ultrasonography (POCUS) in hemophilia A: a commentary on current status and its potential role for improving prophylaxis management in severe hemophilia A. Ther Adv Hematol. 2017;8:153–166.CrossRefGoogle Scholar
  2. 2.
    Altisent C, Martorell M, Crespo A, Casas L, Torrents C, Parra R. Early prophylaxis in children with severe haemophilia A: clinical and ultrasound imaging outcomes. Haemophilia. 2016;22:218–224.CrossRefGoogle Scholar
  3. 3.
    American College of Rheumatology Musculoskeletal Ultrasound Task Force. Ultrasound in American rheumatology practice: report of the American College of Rheumatology musculoskeletal ultrasound task force. Arthritis Care Res (Hoboken). 2010;62:1206–1219.CrossRefGoogle Scholar
  4. 4.
    Aznar JA, Abad-Franch L, Perez-Alenda S, Haya S, Cid AR, Querol F. Ultrasonography in the monitoring of management of haemarthrosis. Haemophilia. 2011;17:826–828.CrossRefGoogle Scholar
  5. 5.
    Barr L, Hatch N, Roque PJ, Wu TS. Basic ultrasound-guided procedures. Crit Care Clin. 2014;30:275–304.CrossRefGoogle Scholar
  6. 6.
    Berntorp E, Shapiro AD. Modern haemophilia care. Lancet. 2012;379:1447–1456.CrossRefGoogle Scholar
  7. 7.
    Carulli C, Matassi F, Civinini R, Morfini M, Tani M, Innocenti M. Intra-articular injections of hyaluronic acid induce positive clinical effects in knees on patients affected by haemophilic arthropathy. Knee. 2013; 20:36–39.CrossRefGoogle Scholar
  8. 8.
    Ceponis A, Wong-Sefidan I, Glass CS, von Drygalski A. Rapid musculoskeletal ultrasound for painful episodes in adult haemophilia patients. Haemophilia. 2013;19:790–798.CrossRefGoogle Scholar
  9. 9.
    Chen B, Lai LP, Putcha N, Stitik TP, Foye PM, DeLisa JA. Optimal needle placement for ultrasound-guided knee joint injections or aspirations. J Trauma Treat. 2014;3:216.Google Scholar
  10. 10.
    Di Minno MN, Iervolino S, Soscia E, Tosetto A, Coppola A, Schiavulli M, et al. Magnetic resonance imaging and ultrasound evaluation of “healthy” joints in young subjects with severe haemophilia A. Haemophilia. 2013;19:e167–173.CrossRefGoogle Scholar
  11. 11.
    Di Minno MN, Pasta G, Airaldi S, Zaottini F, Storino A, Cimino E, et al. Ultrasound for early detection of joint disease in patients with hemophilic arthropathy. J Clin Med. 2017;6(8):E77.CrossRefGoogle Scholar
  12. 12.
    Doria AS. State-of-the-art imaging techniques for the evaluation of haemophilic arthropathy: present and future. Haemophilia. 2010;16 (Suppl 5):107–114.CrossRefGoogle Scholar
  13. 13.
    Doria AS, Keshava SN, Mohanta A, Jarrin J, Blanchette V, Srivastava A, et al. Diagnostic accuracy of ultrasound for assessment of hemophilic arthropathy: MRI correlation. Am J Roentgenol. 2015;204:W336–347.CrossRefGoogle Scholar
  14. 14.
    Fischer K, van Hout BA, van der Bom JG, Grobbee DE, van den Berg HM. Association between joint bleeds and Pettersson scores in severe haemophilia. Acta Radiol. 2002;43:528–532.CrossRefGoogle Scholar
  15. 15.
    Fischer K, Poonnoose P, Dunn AL, Babyn P, Manco-Johnson MJ, David JA, et al. Participants of the International Symposium on Outcome Measures in Hemophilic Arthropathy. Choosing outcome assessment tools in haemophilia care and research: a multidisciplinary perspective. Haemophilia. 2017;23:11–24.CrossRefGoogle Scholar
  16. 16.
    Foppen W, van der Schaaf IC, Fischer K. Value of routine ultrasound in detecting early joint changes in children with haemophilia using the Haemophilia Early Arthropathy Detection with UltraSound protocol. Haemophilia. 2016;22:121–125.CrossRefGoogle Scholar
  17. 17.
    Foppen W, Fischer K, van der Schaaf IC. Imaging of haemophilic arthropathy: Awareness of pitfalls and need for standardization. Haemophilia. 2017;23:645–647.CrossRefGoogle Scholar
  18. 18.
    Hanley J, McKernan A, Creagh MD, Classey S, McLaughlin P, Goddard N, et al. Musculoskeletal Working Party of the UKHCDO. Guidelines for the management of acute joint bleeds and chronic synovitis in haemophilia: A United Kingdom Haemophilia Centre Doctors’ Organisation (UKHCDO) guideline. Haemophilia. 2017;23:511–520.CrossRefGoogle Scholar
  19. 19.
    Keshava S, Gibikote S, Mohanta A, Doria AS. Refinement of a sonographic protocol for assessment of haemophilic arthropathy. Haemophilia. 2009;15:1168–1171.CrossRefGoogle Scholar
  20. 20.
    Kidder W, Nguyen S, Larios J, Bergstrom J, Ceponis A, von Drygalski A. Point-of-care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful haemophilic arthropathy. Haemophilia. 2015;21:530–537.CrossRefGoogle Scholar
  21. 21.
    Klukowska A, Czyrny Z, Laguna P, Brzewski M, Serafin-Krol MA, Rokicka Milewska R. Correlation between clinical, radiological and ultrasonographical image of knee joints in children with haemophilia. Haemophilia. 2001;7:286–92.CrossRefGoogle Scholar
  22. 22.
    Ligocki CC, Abadeh A, Wang KC, Adams-Webber T, Blanchette VS, Doria AS. A systematic review of ultrasound imaging as a tool for evaluating haemophilic arthropathy in children and adults. Haemophilia. 2017;23:598–612.CrossRefGoogle Scholar
  23. 23.
    Lin HM, Learch TJ, White EA, Gottsegen CJ. Emergency joint aspiration: a guide for radiologists on call. Radiographics. 2009;29:1139–58.CrossRefGoogle Scholar
  24. 24.
    Lisi C, Di Natali G, Sala V, Tinelli C, Canepari M, Gamba G, Toffola ED. Interobserver reliability of ultrasound assessment of haemophilic arthropathy: radiologist vs. non-radiologist. Haemophilia. 2016;22:e211–e214.CrossRefGoogle Scholar
  25. 25.
    Manners PJ, Price P, Buurman D, Lewin B, Smith B, Cole CH. Joint aspiration for acute hemarthrosis in children receiving factor VIII prophylaxis for severe hemophilia: 11-year safety data. J Rheumatol. 2015;42:885–890.Google Scholar
  26. 26.
    Martin EJ, Cooke EJ, Ceponis A, Barnes RF, Moran CM, Holle S, Hughes TH, Moore RE, von Drygalski A. Efficacy and safety of point-of-care ultrasound-guided intra-articular corticosteroid joint injections in patients with haemophilic arthropathy. Haemophilia. 2017;23:135–143.CrossRefGoogle Scholar
  27. 27.
    Martinoli C, Della Casa Alberighi O, Di Minno G, Graziano E, Molinari AC, et al. Development and definition of a simplified scanning procedure and scoring method for Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US). Thromb Haemost. 2013;109:1170–1179.CrossRefGoogle Scholar
  28. 28.
    Melchiorre D, Linari S, Innocenti M, Biscoglio I, Toigo M, Cerinic MM, Morfini M. Ultrasound detects joint damage and bleeding in haemophilic arthropathy: a proposal of a score. Haemophilia. 2011;17:112–117.CrossRefGoogle Scholar
  29. 29.
    Merchan ECR, De Orbe A, Gago J. Ultrasound in the diagnosis of the early stages of hemophilic arthropathy of the knee. Acta Orthop Belg. 1992;58:122–125.PubMedGoogle Scholar
  30. 30.
    Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–757.CrossRefGoogle Scholar
  31. 31.
    Muça-Perja M, Riva S, Grochowska B, Mangiafico L, Mago D, Gringeri A. Ultrasonography of haemophilic arthropathy. Haemophilia. 2012;18:364–368.CrossRefGoogle Scholar
  32. 32.
    Nacca C, Harris A, Tuttle J. Hemophilic arthropathy. Orthopedics. 2017;29:1–7.Google Scholar
  33. 33.
    Nguyen S, Lu X, Ma Y, Du J, Chang EY, von Drygalski A. Musculoskeletal ultrasound for intra-articular bleed detection: a highly sensitive imaging modality compared to conventional magnetic resonance imaging. J Thromb Haemost. 2017.  https://doi.org/10.1111/jth.13930
  34. 34.
    Nicolaou S, Talsky A, Khashoggi K, Venu V. Ultrasound-guided interventional radiology in critical care. Crit Care Med. 2007;35(Suppl):S186–S197.CrossRefGoogle Scholar
  35. 35.
    Oldenburg J, Zimmermann R, Katsarou O, Zanon E, Kellermann E, Lundin B, et al. Potential biomarkers of haemophilic arthropathy: correlations with compatible additive magnetic resonance imaging scores. Haemophilia. 2016;22:760–764.CrossRefGoogle Scholar
  36. 36.
    Poonnoose PM, Hilliard P, Doria AS, Keshava SN, Gibikote S, Kavitha ML, et al. Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study. Haemophilia. 2016;22:925–933.CrossRefGoogle Scholar
  37. 37.
    Querol F, Rodriguez-Merchan EC. The role of ultrasonography in the diagnosis of the musculo-skeletal problems of haemophilia. Haemophilia. 2012;18:e215–e226.CrossRefGoogle Scholar
  38. 38.
    Querol F, Cortina V, Cid AR, Haya S, Aznar JA. Clinical and echographical control protocol of haemarthrosis in haemophilia patients with inhibitors: evaluation of the efficacy of recombinant factor VIIa in the evolution process (EFFISEVEN protocol). Haemophilia. 2008;14 (Suppl 6):36–44.CrossRefGoogle Scholar
  39. 39.
    Robertson JD, Connolly B, Hilliard P, Wedge J, Babyn P, Carcao M. Acute haemarthrosis of the hip joint: rapid convalescence following ultrasound-guided needle aspiration. Haemophilia. 2009;15:390–393.CrossRefGoogle Scholar
  40. 40.
    Rodriguez-Merchan EC. Bleeding in hemophilia. Cardiovasc Hematol Disord Drug Targets. 2016;16:21–24.CrossRefGoogle Scholar
  41. 41.
    Rodriguez-Merchan EC, Jimenez-Yuste V, Aznar JA, Hedner U, Knobe K, Lee CA, et al. Joint protection in haemophilia. Haemophilia. 2011;17 (Suppl 2):1–23.CrossRefGoogle Scholar
  42. 42.
    Rodriguez-Merchan EC, De la Corte-Rodriguez H, Jimenez-Yuste V. Radiosynovectomy in haemophilia: long-term results of 500 procedures performed in a 38-year period. Thromb Res. 2014;134:985–990.CrossRefGoogle Scholar
  43. 43.
    Sierra-Aisa C, Lucía Cuesta JF, Rubio Martínez A, Fernández Mosteirín N, Iborra Muñoz A, Abío Calvete M, et al. Comparison of ultrasound and magnetic resonance imaging for diagnosis and follow-up of joint lesions in patients with haemophilia. Haemophilia. 2014;20:e51–e57.CrossRefGoogle Scholar
  44. 44.
    Strike KL, Iorio A, Jackson S, Lawson W, Scott L, Squire S, et al. Point-of-care ultrasonography in haemophilia care: recommendations for training and competency evaluation. Haemophilia. 2015;21:828–831.CrossRefGoogle Scholar
  45. 45.
    Timmer MA, Foppen W, Schutgens RE, Pisters MF, Fischer K. Comparing findings of routine Haemophilia Joint Health Score and Haemophilia Early Arthropathy Detection with UltraSound assessments in adults with haemophilia. Haemophilia. 2017;23:e141–e143.CrossRefGoogle Scholar
  46. 46.
    Zukotynski K, Jarrin J, Babyn PS, Carcao M, Pazmino-Canizares J, Stain AM, et al. Sonography for assessment of haemophilic arthropathy in children: a systematic protocol. Haemophilia. 2007;13:293–304.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2018

Authors and Affiliations

  • Hortensia De la Corte-Rodriguez
    • 1
  • E. Carlos Rodriguez-Merchan
    • 2
    Email author
  • Víctor Jimenez-Yuste
    • 3
  1. 1.Department of Physical Medicine and RehabilitationLa Paz University Hospital–IdiPazMadridSpain
  2. 2.Department of Orthopaedic SurgeryLa Paz University Hospital–IdiPazMadridSpain
  3. 3.Department of HematologyLa Paz University Hospital–IdiPazMadridSpain

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