The role of standard roentgenography and computed tomography in the diagnosis of hemophilic arthroses

Purpose. To determine the role of the integrated use of the techniques of standard roentgenography and computed tomography in assessing the severity of joint destruction in patients with hemophilia. Material and Methods. The work is based on analyzing the results of examination and treatment of 87 patients with hemophilic arthropathies of large joints. They were treated in JSC “RNTsNPM” specialized department of restorative orthotic surgery and polytrauma, their mean age was 42.5±10.3 years, they had the diagnosis of hemophilia A revealed by laboratory tests, and they were considered disabled persons with disability group II-III since childhood. There were 104 knees and 9 hips among 113 joints examined by the techniques of roentgenography and computed tomography. Results. Roentgenographic data revealed no pathology in 26% joints among 104 knees examined (when patients complained of pain in the joints), Stage I determined in 5.8%, Stage II - in 6.7%, Stage III - in 37.5%, and Stage IV - in 24%, as for the hip examination, Stage III-IV determined (according to E.Z. Novikova classification /1967/). In recent years X-ray computed tomography has been widely used in order to determine bone changes at different stages of hemophilic osteoarthroses more accurately. The authors propose a technique of semiquantitative evaluation of hemophilic arthrosis progression for standard roentgenography supplemented by CT data. For CT of 104 knees: among 26% of the joints without X-ray signs of arthrosis by X-rays, Stage I and II arthrosis revealed by CT, as well as CT signs of osteoporosis as local areas of bone tissue rarefaction revealed in all the joints, while regional osteoporosis by X-rays observed in 50.6%. Unlike roentgenography CT is of high sensitivity in diagnosing the signs of hemophilic arthropathies (91.8 % and 72.7 %, respectively), while roentgenography specificity is superior to CT specificity (86.4% and 71.3%). These two techniques complement each other that confirmed by the analysis of diagnostic test operation characteristics. When combining X-ray+CT techniques sensitivity increases to 96.7%, at the same time diagnostic sensitivity/specificity ratio is optimal (3:2). Conclusion. The proposed technique of semiquantitative evaluation of hemophilic arthrosis progression using standard roentgenography supplemented by CT data with detailing the roentgen-tomographic semiotics of different stages of hemophilic arthropathies which has the diagnostic sensitivity of 96.7% can serve as practical recommendations for physicians - roentgenologists, hematologists, traumatologists-orthopedists. Timely determination of the stage of changes in joints for hemophilia contributes to prescribing the adequate therapy which can significantly influence the disease evolution prognosis, as well as it allows to reveal indications for joint arthroplasty.