Abstract
Background
Bleeding into the joints cause major morbidity in haemophilia patients. The clinical hallmark of haemophilia is haemarthrosis especially in knee, ankle and elbow joint. Current literature suggests that aspiration of an acute haemarthrosis in haemophilia may lead to further bleeding and prevent tamponade effect. But the rehabilitation gets delayed, leading to joint stiffness and the function gets deteriorated. This study was done to evaluate the efficacy of joint aspiration in the management of acute knee haemarthrosis, with regard to pain relief and functional outcome.
Materials and Methods
This is a prospective, randomised controlled trial in a tertiary care haemophilia treatment centre comprising 120 haemophilic patients with unilateral acute knee haemarthrosis. Factor level was checked and appropriate factor replacement [40%] was done. The patients were randomly allocated in two groups: Group A and Group B, each consisting of 60 patients. All patients received ice application, limb immobilisation, analgesics, physiotherapy and compression bandage as the routine primary management. In addition, study Group A also received therapeutic aspiration of the knee joint at initial presentation, after the first factor infusion. All patients were clinically evaluated for pain in terms of Visual Analogue Scale (VAS score) and function in terms of Haemophilic Joint Health Score [HJHS], before and at 4 h, 48 h and 7 days after initial factor administration.
Results
All patients showed therapeutic improvement in terms of a declining trend in VAS and HJHS scores. Pain relief (VAS Score) in Group A, was found to be significantly better compared to Group B at the end of 4 h [4.80 ± 0.49 vs 6.54 ± 1.05; p < 0.001], 48 h [2.48 ± 0.50 vs 3.30 ± 0.46; p < 0.001] and 7 days [1.16 ± 0.37 vs 1.70 ± 0.46; p < 0.001]. Functional improvement (HJHS Score) in Group A, was found to be significantly better compared to Group B as well at the end of 4 h [11.24 ± 0.77 vs 14.52 ± 0.61; p < 0.001], 48 h [7.24 ± 0.65 vs 11.28 ± 0.64; p < 0.001] and 7 days [2.36 ± 0.48 vs 5.52 ± 0.67; p < 0.001].
Conclusion
Our study recommends the use of joint aspiration as a therapeutic tool in the holistic management of acute knee haemarthrosis in addition to usual treatment of ice application, immobilization and oral tranexamic acid. Early factor replacement along with therapeutic joint aspiration is a key for better pain relief and a better functional outcome.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lafeber, F. P. G. J., Miossec, P., & Valentino, L. A. (2008). Physiopathology of haemophilic arthropathy. Haemophilia, 14(Suppl. 4), 3–9.
Shima, M. (2013). Haemophilia. Rinsho Ketsueki, 54(2), 189–197. Japanese.
Rosendaal, F., Aledort, L., Lusher, J., Rothschild, C., Ingerslev, J., & White, G. (2001). Definitions in haemophilia. Thrombosis and Haemostasis, 85(03), 560–560. https://doi.org/10.1055/s-0037-1615621
De la Corte-Rodriguez H, Rodriguez-Merchan EC, Alvarez-Roman MT, Martin-Salces M, Romero-Garrido JA, Jimenez-Yuste V. Accelerating recovery from acute hemarthrosis in patients with hemophilia: the role of joint aspiration. Blood Coagul Fibrinolysis. 2019 Apr;30(3):111-119. https://doi.org/10.1097/MBC.0000000000000803. PMID: 30958454.
Srivastava, Brewer, A. K., Mauser-Bunschoten, E. P., Key, N. S., Kitchen, S., & Llinas, A. (2012). Guidelines for the management of haemophilia. Haemophilia, 19(1), e1–e47. https://doi.org/10.1111/j.1365-2516.2012.02909.x
Rodriguez-Merchan, E. C. (2018). Treatment of musculo-skeletal pain in haemophilia. Blood Reviews, 32(2), 116–121. https://doi.org/10.1016/j.blre.2017.09.004 Epub 2017 Sep 19.
van Dixhoorn, J., Duivenvoorden, H. J., Staal, H. A., & Pool, J. (1989). Physical training and relaxation therapy in cardiac rehabilitation assessed through a composite criterion for training outcome. American Heart Journal, 118(3), 545–552. https://doi.org/10.1016/0002-8703(89)90271-8
Bartels, E. M., Juhl, C. B., Christensen, R., Hagen, K. B., Danneskiold-Samsøe, B., Dagfinrud, H., & Lund, H. (2016). Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews, 3, CD005523. https://doi.org/10.1002/14651858.CD005523.pub3
Bijur, P. E., Silver, W., & Gallagher, E. J. (2001). Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine, 8(12), 1153–1157. https://doi.org/10.1111/j.1553-2712.2001.tb01132.x
Ribeiro, T., Abad, A., & Feldman, B. M. (2019). Developing a new scoring scheme for the hemophilia joint health score 2.1. Research and Practice in Thrombosis and Haemostasis, 3(3), 405–411. https://doi.org/10.1002/rth2.12212
Banta, J. V., Boone, D. C., & Smith, C. F. (1975). Arthrocentesis of the knee in acute hemophilic arthropathy. Western Journal of Medicine, 122, 285–288.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
All authors have contributed towards the writing, editing, supervision and validation of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
None.
Institutional ethics approval
Prior approval was taken by Institutional Ethics Committee and Departmental Review Board.
Informed consent
Informed verbal and written consent of the patient were taken for clinical pictures and the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Rai, A.K., Mohanty, S.S., Rathod, T.N. et al. Outcome of Joint Aspiration in Acute Knee Haemarthrosis in a Haemophilic Joint: A Prospective Randomised Controlled Trial in 120 Patients in a Tertiary Haemophilia Care Centre. JOIO 56, 2060–2065 (2022). https://doi.org/10.1007/s43465-022-00745-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-022-00745-x