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Hamostaseologie
DOI: 10.1055/a-2781-8742
Original Article

Extraarticular and Intraarticular Key Lesions in Knee Joints of Adult Persons with Hemophilia—A Case-Control Ultrasound Study

Authors

  • Meike Hoffmeister  ‡

    1   Johanniter-Klinik am Rombergpark, Dortmund, Germany (Ringgold ID: RIN62620)

  • Steffen Herzig‡

    2   Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany (Ringgold ID: RIN26603)

  • Alexander Schmidt 

    2   Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany (Ringgold ID: RIN26603)

  • Jamil Hmida 

    2   Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany (Ringgold ID: RIN26603)

  • Fabian Tomschi 

    2   Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany (Ringgold ID: RIN26603)

  • Thomas Hilberg 

    2   Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany (Ringgold ID: RIN26603)

The authors have received funding for research carried out in this work by Baxalta, now part of Takeda and former Shire, Germany.
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Abstract

Background: Persons with hemophilia (PwH) develop arthropathic changes due to recurrent hemarthroses. This study aimed to comprehensively investigate structural knee joint alterations in PwH, extended beyond synovitis and osteochondral abnormalities, and to compare findings with healthy controls (Con).

Methods: Bilateral knee ultrasound examinations were performed in 36 male PwH (severe A: 30, B: 2; moderate A: 3, B: 1; mean age: 47.1 ± 12.0) and 39 age-matched Con (mean age: 47.7 ± 12.8). A total of 26 landmarks and tissues, including synovium, osteophytes, ligaments, tendons, and bursae, were assessed quantitatively or semi-quantitatively. Clinical joint status was classified using the Hemophilia Joint Health Score, distinguishing between minorly (PwH-MI) and majorly (PwH-MA) affected joints.

Results: Synovium, osteophytes, ligaments, and bursae showed more pronounced alterations in PwH compared to Con. While the iliotibial band was slightly thicker in PwH (p = 0.023), the popliteus tendon (p = 0.001) and patellar tendon at the tibial insertion were significantly thinner. PwH-MA showed significant changes at all landmarks (p < 0.001), while PwH-MI demonstrated differences only in the lateral knee joint synovium (p = 0.006) compared to Con. Osteophytes and synovium were significantly thicker in PwH-MA than in PwH-MI.

Conclusion: The findings highlight the importance of assessing periarticular structures in PwH, as changes may contribute to functional impairments such as gait deviations. Further research is required to clarify the clinical implications.

Keywords

Hemophilia - Hemophilic arthropathy - Rare disease - Sonography - Ultrasound

Ethics Approval Statement

This study was approved by the local Ethical Review Boards (University of Wuppertal MS/BB). All participants provided written informed consent.


Patient Consent Statement

Informed consent was obtained from all individual participants included in the study.


Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.


Supplementary Material



Publication History

Received: 23 August 2025

Accepted after revision: 07 January 2026

Article published online:
27 January 2026

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