Standardized joint-ultrasound for individualization of prophylaxis in hemophiliacs: Easy-to-learn-ultrasonography (HEAD-US) of joints and correlation with function and clinics

Purpose: In Haemophilic Arthropathy the extent of synovitis is detected as a sign of the activity, osteochondral defects are quantifiable as a sign of progression by ultrasound. In 2013 an easy-to-use standardized ultrasound protocol (HEAD-US) for examination of early joint changes in Hemophilic Arthropathy was published by C. Martinoli. The results of the first clinical trial to correlate clinics, functional and structural changes in Haemophilic Arthropathy are shown here.

Material and methods: In 2012 – 2015 we have included more than 200 young german patients with hemophilia A or B or vWD from different German haemophilia treatment centers in the HaemarthroSonoPilot trial (DRKS00004483, informed consent, ethical approved by the LÄK Baden-Württemberg). Standardized Ultrasound of the elbow, knee and ankle joints was performed and rated with the HEAD-US scale in each patient. Simultaneously an orthopedic clinical examination with clinical scoring and 3D motion analysis of the lower limbs for detecting early function defects (rolling vs. gliding in motion) were performed with an ultrasonic topometer.

Results: The investigations in the presented pilot study showed correlation of the sonographic diagnostics with the measurement of a clinical orthopedic examination in haemophilic arthropathy depending on age. Through the joint sonography changes were even partially already seen before that stood out in the clinical investigation.

Conclusions: It may be useful if haemophilia treaters in future apply an easy to learn standardized ultrasonography (HEAD-US) to individualize the therapy under close control and evaluation of joint changes.