Joint lavage followed by viscosupplementation and triamcinolone in patients with severe haemophilic arthropathy: objective functional results

Introduction Viscosupplementation can improve function in haemophilia patients. Viscosupplementation results can be improved by prior joint lavage and triamcinolone administration. Aim To objectively assess whether viscosupplementation and associated triamcinolone use in patients with severe haemophilic arthropathy following joint lavage improves force and balance and reduces bleeding events. Methods Fourteen patients with haemophilic knee arthritis with and without the involvement of other joints underwent joint lavage and subsequent injections of Hylan G‐F20 and triamcinolone into all affected joints. Patients were evaluated with NeuroCom® force and balance platforms using the step‐up‐and‐over task (STP), sit‐to‐stand test (STS), one‐leg stance (UNI) and weight‐bearing squat (WBS) at baseline and at 1, 3, 6 and 12 months after the procedure. Bleeding events in the year prior to and the year after the procedure were analysed. Results Sixteen knees, 15 ankles, eight elbows and one shoulder were treated. The STP results indicated improvements in the lift‐up indices (right leg) at all time points evaluated (P = 0.03). The STS results revealed coupled improvement in weight transfer and the rising index for up to a year (P = 0.02). Balance (UNI) with eyes open or closed improved in all evaluations. The WBS results revealed improvements at all degrees of flexion (0, P = 0.003; 30°, P = 0.001; 60°, P < 0.001 and 90°, P < 0.001). The numbers of total and traumatic bleeding events were reduced (P = 0.04). Conclusion Joint lavage followed by injections of triamcinolone and Hylan G‐F20 improved balance, function and bleeding events in severe haemophilic arthropathy patients.