Hemarthrosis: Causes, Symptoms, Treatment

What is Hemarthrosis?

Hemarthrosis is a pathological condition of the joint characterized by bleeding into the joint cavity. Some joints have recurrent episodes of bleeding into the cavity. These joints are referred to as target joint. This implies that the joint has had more than or equal to at least four bleeding episodes over a span of six months. Hemarthrosis mostly affects the joints of the knees, elbows, ankles and in some instances the hip, shoulder, and wrist. The prevalence of this condition is not clearly mentioned in the literature but some reports suggest that around 50% of general population get affected by Hemarthrosis at some point or the other.[1]

The chances of an individual developing Hemarthrosis increases significantly if he or she incurs a trauma or blow to a joint. This has been verified by a study in which around 1200 people who developed Hemarthrosis of the knee had an injury to their anterior cruciate ligament. Hemarthrosis also is seen quite commonly in people with a genetic disorder called hemophilia. This is a condition in which the protein responsible for clotting which is factor VIII or Factor IX is entirely missing.[1]

Hemarthrosis over a period of time starts causing damage to the joint which may become irreparable. This ultimately affects joint mobility and flexibility which in some instances can cause permanent disability. The extent of damage to the joint is dependent on the severity of the bleeding within the joint cavity.[1]

An individual with Hemarthrosis will experience pain, deformity of joint, and swelling due to the pressure that the blood that fills in the cavity puts on the joint. The presenting feature of this condition is quite similar to that of arthritis.[1]

What Causes Hemarthrosis?

As stated, Hemarthrosis is commonly seen in people with a genetic condition called hemophilia. Studies estimate that approximately 1 in every 5000 newborns is diagnosed with hemophilia in the United States and as of now there are around 20,000 people with hemophilia in the United States. The elderly population with a known diagnosis of hemophilia is at an increased risk of developing or may have already developed Hemarthrosis. The reason cited for this is lack of proper treatment for hemophilia when they were young.[2]

However, children born with hemophilia in the 21st century receive advanced treatment and have less likelihood of developing Hemarthrosis in the future. Some of the other causes for Hemarthrosis include a trauma or injury to a joint. This trauma can be due to repetitive stress injury, sprain, or the joint getting damaged or injured after a sporting or a motor vehicle accident.[2]

People who are on chronic anticoagulants or blood thinners are also at increased risk for Hemarthrosis. At times, people develop joint infections. This is also a big risk factor for Hemarthrosis. Leukemia or blood cancer also at times leads to the development of this condition. Hemarthrosis of the knees is mostly caused due to ligament injury, tears, fractures and frequent episodes of knee dislocations. In the elbows, Hemarthrosis is normally caused by a trauma such as falling on the elbow during sporting injury.[2]

What are the Symptoms of Hemarthrosis?

The primary presenting features which points towards development of Hemarthrosis includes increased temperature around the affected joint. There will be visible swelling around the joint. In newborns with joint bleeding there will be inconsolable crying without any specific reason. As the condition progresses, the symptoms will get worse and the joint will become stiff. The patient will find it difficult to move the joint especially if the elbow or the knee joints are affected.[2]

The range of motion of the affected joint will also decrease as the condition progresses with worsening pain with any attempts at motion. In cases of children with Hemarthrosis, they will not be able to keep the affected joint straight or put any weight on it.[2]

How is Hemarthrosis Treated?

The treatment for Hemarthrosis depends on the cause of it and the degree of damage caused to the affected joint. If Hemarthrosis is believed to be a result of another medical condition like osteoporosis or hemophilia then treatment for the underlying condition will have to be done along with treating Hemarthrosis. Surgery is the most preferred route to treat Hemarthrosis. This not only restores range of motion and flexibility of the joint but also improves pain and quality of life of the patient. In people who have a known diagnosis of hemophilia then the surgical options for treatment of Hemarthrosis needs to be closely discussed by the hematologist before embarking on this form of treatment.[2]

However, due to the advancement made in the treatment of hemophilia, there are medications available which replace the missing protein in the patient and in most cases prevent the development of Hemarthrosis. For treatment of this condition, there are two surgical options synovectomy and joint replacement. Synovectomy is a procedure in which the synovium, which is the primary lubricating agent in the joint and also gets rid of any debris or fluid present in the joint, is removed. This is because synovial fluid contains blood vessels which are a major source of bleeding into the joint cavity.[2]

Once the synovium is removed completely then any chances of further development of Hemarthrosis goes down to a minimum. This procedure will not make the individual completely functional but helps a great deal in dealing with pain and restricted range of motion. It also improves the quality of life of the affected individual substantially. There are three approaches of doing a synovectomy, namely radioactive, open, and arthroscopic.[2]

Radioactive synovectomy involves injection of a radioactive dye into the affected joint and using this material the synovial fluid is removed. Arthroscopic synovectomy involves making small incisions around the affected joint and removing the synovial fluid. An open synovectomy involves completely opening up the affected joint and removing the synovial fluid.[2]

A joint replacement is only considered as a last resort for treatment of Hemarthrosis. This is done for people who find other forms of treatment ineffective. Joint replacement is also done for people who have an extremely poor quality of life as a result of pain and restricted range of motion caused by Hemarthrosis. This procedure involves complete removal of the damaged joint and replacing it with artificial components. These components are usually made of plastic or metals.[2]

The surgery is generally limited to the knee and hip Hemarthrosis. After joint replacement, once the new joint settles in, there is complete alleviation of pain and there is no limitation in range of motion. A replaced joint in majority of the cases lasts for a minimum 10 years. There are also certain other procedures that are quite effective for treating Hemarthrosis. These procedures include cheilectomy, arthrodesis, and osteotomy of the affected joint.[2]

Once the patient has undergone surgery for Hemarthrosis, it is vital for him or her to get enrolled in physical therapy. Physical therapy is important for reducing inflammation, reliving postoperative pain, improving flexibility and range of motion, and most importantly to improve strength of the affected joint. Additionally, there are also certain lifestyle changes that an individual with Hemarthrosis will have to make post treatment. This will include diligent exercises, as much as possible and the body allows to help the joints stay strong and mobile.[2]

In case if an individual is overweight then losing extra pounds is also quite effective. If an individual has had a previous episode of Hemarthrosis then it is better to avoid getting that joint reinjured.[2]

In conclusion, Hemarthrosis is a condition which can definitely be treated even though it requires surgical procedure. The surgery that will be done will depend on the severity of the condition and to the extent that the joint has been damaged by the bleeding. Postprocedure, the patient will have to get involved with physical therapy to keep the joint mobile and strong.[2]

It will also help in alleviation of any residual postoperative pain and discomfort. There are certain lifestyle changes that are required in an individual with Hemarthrosis. These include exercising regularly, eating a healthy and balanced diet to keep the bones and cartilage strong, and shedding off extra weight. This will put less pressure on the joints and will prevent future episodes of Hemarthrosis.[2]

Reference:

  1. https://www.ncbi.nlm.nih.gov/books/NBK525999/
  2. https://www.medicalnewstoday.com/articles/320443.php

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