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Gualtierotti R, Giachi A, Suffritti C, Bedogni L, Franco F, Poggi F, Mascetti S, Colussi M, Ahmetovic D, Begnozzi V, Boccalandro EA, Solimeno LP, Peyvandi F. Optimizing long-term joint health in the treatment of hemophilia. Expert Rev Hematol 2024; 17:713-721. [PMID: 39245933 DOI: 10.1080/17474086.2024.2396617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 08/21/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION The improved quality of care and increased drug availability have shifted the goal of treating people with hemophilia from life-threatening bleeding prevention to joint health preservation and quality of life amelioration. Many tools are now available to the clinician in order to optimize the management of hemophilic arthropathy. AREAS COVERED This paper reviews the pivotal role of ultrasound evaluation in early detection of joint bleeding and differential diagnosis of joint pain, with a focus on the feasibility of a long-term monitoring of joint health through the use of artificial intelligence and telemedicine. The literature search methodology included using keywords to search in PubMed and Google Scholar, and articles used were screened by the coauthors of this review. EXPERT OPINION Joint ultrasound is a practical point-of-care tool with many advantages, including immediate correlation between imaging and clinical presentation, and dynamic evaluation of multiple joints. The potential of telemedicine care, coupled with a point-of-care detection device assisted by artificial intelligence, holds promises for even earlier diagnosis and treatment of joint bleeding. A multidisciplinary approach including early intervention by physical medicine and rehabilitation (PMR) physicians and physiotherapists is crucial to ensure the best possible quality of life for the patient.
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Affiliation(s)
- Roberta Gualtierotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Andrea Giachi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Suffritti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Luca Bedogni
- Dipartimento di Scienze Fisiche, Informatiche e Matematiche, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Francesco Franco
- Dipartimento di Scienze Fisiche, Informatiche e Matematiche, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Francesco Poggi
- Institute for Cognitive Sciences and Technologies (ISTC), National Research Council (CNR), Bologna, Italy
| | - Sergio Mascetti
- Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Marco Colussi
- Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Dragan Ahmetovic
- Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Valentina Begnozzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Elena Anna Boccalandro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Luigi Piero Solimeno
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Orthopaedic Surgery and Traumatology, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Cruz-Montecinos C, Devia C, Barahona M, Manzur H, Toledo J. Comparison of the kinematic analysis of indoor and outdoor gait in people with haemophilia and total knee replacement. Haemophilia 2024; 30:1102-1104. [PMID: 38853008 DOI: 10.1111/hae.15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/03/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Carlos Cruz-Montecinos
- Department of Physical Therapy, Laboratory of Clinical Biomechanics, Faculty of Medicine, University of Chile, Santiago, Chile
- Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Christ Devia
- Departamento de Neurociencias, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Centro Nacional de Inteligencia Artificial, CENIA, Santiago, Chile
| | | | - Hachi Manzur
- Hospital Clínico Universidad de Chile, Santiago, Chile
- Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jorge Toledo
- Red de Equipamiento Avanzado REDECA, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Zhai T, Song Y, Su J, Wu R, Wang J, Zhang Z, Feng W. Study protocol for a randomized controlled trial: evaluating the effect of isokinetic eccentric training of the hamstring on knee function and walking function after total knee arthroplasty. Front Med (Lausanne) 2024; 11:1404736. [PMID: 38846149 PMCID: PMC11155448 DOI: 10.3389/fmed.2024.1404736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Total knee arthroplasty (TKA) is a widely-used treatment for end-stage knee osteoarthritis. However, it is common for patients to experience issues with knee joint function and abnormal gait following the surgery. Previous studies have primarily focused on concentric contraction of the quadriceps during TKA, neglecting the potential benefits of eccentric isokinetic training for the hamstrings. This protocol outlines a randomized, single-blind, controlled trial aimed at assessing the impact of eccentric isokinetic training for the hamstring muscles on pain, function, and gait in patients after TKA. Methods and analysis Fifty participants between the ages of 50 and 80 with knee osteoarthritis undergo unilateral total knee arthroplasty (TKA) for the first time. They will be transferred to the rehabilitation department 10-14 days after the operation. The participants are randomly divided into two groups, with 25 participants in each group: the control group and the Hamstring training group. The Control group will receive routine rehabilitation treatment, while the Hamstring training group will receive a combination of routine rehabilitation treatment and isokinetic eccentric training of the hamstring. The intervention will last four consecutive weeks. Both groups will be assessed at three different times: before the intervention, after 4 weeks of intervention, and 4 weeks after the interventions (follow-up). The primary outcome will be functional capacity (TUGT) and Hospital for Special knee Score (HSS). Secondary outcomes will be knee-related health status (isokinetic knee position perception, Peak torque of hamstring strength), pain intensity (Visual analog scale, VAS) and 3D gait analysis. Discussion The study aims to provide relevant evidence on the effectiveness of eccentric hamstring muscle contraction training in improving knee joint function and walking function after TKA. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=195544, Identifier ChiCTR2300073497.
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Affiliation(s)
- Tianjun Zhai
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Rehabilitation Department, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yongjia Song
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Rehabilitation Department, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jianqing Su
- Rehabilitation Department, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Ruiren Wu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Rehabilitation Department, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jie Wang
- Rehabilitation Department, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Zengqiao Zhang
- Tuina Department, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Feng
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Rehabilitation Department, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
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Mawarikado Y, Sakata A, Inagaki Y, Harada S, Tatsumi K, Matsumoto N, Ogiwara K, Yada K, Yoshimura Y, Kido A, Tanaka Y, Shima M, Nogami K. Force-sensing treadmill gait analysis system can detect gait abnormalities in haemophilia patients without arthropathy. Haemophilia 2024; 30:780-790. [PMID: 38507270 DOI: 10.1111/hae.14987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Joint damage in patients with haemophilia (PwH) is commonly assessed by imaging, but few reports have described how structural changes in joints, for example, haemophilic arthropathy (HA)-affect gait ability. OBJECTIVES We evaluated gait function among PwH with HA, PwH without HA, and people without haemophilia (non-PwH) using a Zebris FDM-T treadmill (FDM-T), an easy-to-use gait assessment instrument with a force sensor matrix. METHODS The following gait parameters were collected: centre of pressure trajectory intersection (COPi) anterior/posterior variability, COPi lateral variability, COPi anterior/posterior symmetry, COPi lateral symmetry, single-limb support line (SLSL) length, and SLSL variability. Participants walked at their typical gait speed. The physical function of the PwH was assessed by the Hemophilia Joint Health Score (HJHS). Parameters were compared among the three groups. RESULTS Twelve PwH with HA, 28 PwH without HA, and 12 non-PwH were enrolled. Gait speed significantly differed between groups (non-PwH, 3.1 ± 0.7; PwH without HA, 2.0 ± 0.7; PwH with HA; 1.5 ± 0.4). The COPi anterior/posterior variability, COPi lateral variability, SLSL length, and SLSL variability were greater in the PwH groups than in the non-PwH group. The COPi lateral symmetry differed between PwH with HA and the other groups. The HJHS was not correlated with gait parameters among PwH with HA. CONCLUSIONS Gait parameters and speed were abnormal in both PwH with HA and PwH without HA. The FDM-T can be used to identify early stages of physical dysfunction that cannot be detected by conventional functional assessments such as the HJHS.
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Affiliation(s)
- Yuya Mawarikado
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
| | - Asuka Sakata
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Inagaki
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Suguru Harada
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Yokohama City, Kanagawa, Japan
| | - Kohei Tatsumi
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
- Advanced Medical Science of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
| | - Naoki Matsumoto
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Yokohama City, Kanagawa, Japan
| | - Kenichi Ogiwara
- Department of Paediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Koji Yada
- Department of Paediatrics, Nara Medical University, Kashihara, Nara, Japan
- Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Yasushi Yoshimura
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Yokohama City, Kanagawa, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Midori Shima
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
| | - Keiji Nogami
- Medicinal Biology of Thrombosis and Haemostasis, Nara Medical University, Kashihara, Nara, Japan
- Department of Paediatrics, Nara Medical University, Kashihara, Nara, Japan
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Lan Z, Lempereur M, Gueret G, Houx L, Cacioppo M, Pons C, Mensah J, Rémy-Néris O, Aïssa-El-Bey A, Rousseau F, Brochard S. Towards a diagnostic tool for neurological gait disorders in childhood combining 3D gait kinematics and deep learning. Comput Biol Med 2024; 171:108095. [PMID: 38350399 DOI: 10.1016/j.compbiomed.2024.108095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
Gait abnormalities are frequent in children and can be caused by different pathologies, such as cerebral palsy, neuromuscular disease, toe walker syndrome, etc. Analysis of the "gait pattern" (i.e., the way the person walks) using 3D analysis provides highly relevant clinical information. This information is used to guide therapeutic choices; however, it is underused in diagnostic processes, probably because of the lack of standardization of data collection methods. Therefore, 3D gait analysis is currently used as an assessment rather than a diagnostic tool. In this work, we aimed to determine if deep learning could be combined with 3D gait analysis data to diagnose gait disorders in children. We tested the diagnostic accuracy of deep learning methods combined with 3D gait analysis data from 371 children (148 with unilateral cerebral palsy, 60 with neuromuscular disease, 19 toe walkers, 60 with bilateral cerebral palsy, 25 stroke, and 59 typically developing children), with a total of 6400 gait cycles. We evaluated the accuracy, sensitivity, specificity, F1 score, Area Under the Curve (AUC) score, and confusion matrix of the predictions by ResNet, LSTM, and InceptionTime deep learning architectures for time series data. The deep learning-based models had good to excellent diagnostic accuracy (ranging from 0.77 to 0.99) for discrimination between healthy and pathological gait, discrimination between different etiologies of pathological gait (binary and multi-classification); and determining stroke onset time. LSTM performed best overall. This study revealed that the gait pattern contains specific, pathology-related information. These results open the way for an extension of 3D gait analysis from evaluation to diagnosis. Furthermore, the method we propose is a data-driven diagnostic model that can be trained and used without human intervention or expert knowledge. Furthermore, the method could be used to distinguish gait-related pathologies and their onset times beyond those studied in this research.
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Affiliation(s)
- Zhengyang Lan
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; IMT Atlantique, LaTIM U1101 INSERM, Brest, France
| | - Mathieu Lempereur
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; CHU de Brest, Hôpital Morvan, service de médecine physique et de réadaptation, Brest, France.
| | - Gwenael Gueret
- CHU de Brest, Hôpital Morvan, service de médecine physique et de réadaptation, Brest, France
| | - Laetitia Houx
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; CHU de Brest, Hôpital Morvan, service de médecine physique et de réadaptation, Brest, France; Fondation Ildys, Brest, France
| | - Marine Cacioppo
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; CHU de Brest, Hôpital Morvan, service de médecine physique et de réadaptation, Brest, France
| | - Christelle Pons
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; CHU de Brest, Hôpital Morvan, service de médecine physique et de réadaptation, Brest, France; Fondation Ildys, Brest, France
| | - Johanne Mensah
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; CHU de Brest, Hôpital Morvan, service de médecine physique et de réadaptation, Brest, France; Fondation Ildys, Brest, France
| | - Olivier Rémy-Néris
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; CHU de Brest, Hôpital Morvan, service de médecine physique et de réadaptation, Brest, France
| | | | - François Rousseau
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; IMT Atlantique, LaTIM U1101 INSERM, Brest, France
| | - Sylvain Brochard
- Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; CHU de Brest, Hôpital Morvan, service de médecine physique et de réadaptation, Brest, France; Fondation Ildys, Brest, France
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Russell S, Whitehart S, Mason J, Window P. Does the method of telehealth delivery affect the physiotherapy management of adults with bleeding disorders? A comparison of audioconferencing and videoconferencing. Haemophilia 2023; 29:1589-1596. [PMID: 37729471 DOI: 10.1111/hae.14869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
AIM To determine whether the method of telehealth delivery (audioconferencing or videoconferencing) affects the physiotherapy management of adults with inherited bleeding disorders. METHODS A cross-sectional observational study was utilised involving 40 physiotherapy consultations (23 initial consultations and 17 follow-up consultations) of adults (>18) with a diagnosed bleeding disorder. Each consultation involved an initial audioconferencing component followed immediately by a separate videoconferencing component. Following each component, the physiotherapist utilised the clinical information gathered to formulate and record a management plan, and additionally recorded their confidence in this plan. Differences between the management plans and clinician confidence were recorded, including where applicable the visual information prompting a change in management plans. RESULTS Audioconferencing and videoconferencing management plans differed in 40% of all consultations, including 52.0% of initial consultations and 23.5% of follow-up consultations. Among consultations where management plans differed, this was prompted by visual information related to the anatomic location of symptoms (31.3%), the absence/presence of swelling (31.3%), joint range of movement (25.0%), and general appearance (12.5%). Median self-reported clinician confidence of management plans increased significantly from 70.0% following audioconferencing to 93.0% following videoconferencing. CONCLUSION When utilizing telehealth, the choice between audioconferencing or videoconferencing may affect physiotherapy management of adults with bleeding disorders, particularly with initial consultations. Videoconferencing potentially leads to more appropriate management plans, clinician confidence and utilization of healthcare resources. Further high-quality studies are required to confirm the findings of this study.
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Affiliation(s)
- Scott Russell
- Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Simon Whitehart
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jane Mason
- Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Peter Window
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
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Scaturro D, Vitagliani F, Tomasello S, Mangano MS, Signa G, Letizia Mauro G. Postural Assessment Systems in the Prevention of Haemophilic Arthropathy: A Narrative Review. J Funct Morphol Kinesiol 2022; 7:jfmk7030068. [PMID: 36135426 PMCID: PMC9504687 DOI: 10.3390/jfmk7030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
This narrative review aims to give an overview of some postural evaluation systems currently used in patients with haemophilia. Among them, first, we analyse the HJHS scale, recognized as a specific evaluation tool for haemophilic arthropathy. Second, we focus on other systems usually used in non-haemophilic patients that have also shown good applicability in this patient category, such as gait analysis, stabilometry, and baropodometric examination. This review underlines the use these tools could have in clinical practice to identify the early postural alterations in patients with haemophilia and set up personalised rehabilitation programs.
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Affiliation(s)
- Dalila Scaturro
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-3206945411
| | - Fabio Vitagliani
- Faculty of Medicine and Surgery, University of Catania, 95100 Catania, Italy
| | - Sofia Tomasello
- Faculty of Medicine and Surgery, University of Palermo, 90127 Palermo, Italy
| | | | - Gabriele Signa
- Faculty of Medicine and Surgery, University of Catania, 95100 Catania, Italy
| | - Giulia Letizia Mauro
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
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Fouasson-Chailloux A, Leboeuf F, Maugars Y, Trossaert M, Menu P, Rannou F, Vinatier C, Guicheux J, Gross R, Dauty M. Gait Alteration Due to Haemophilic Arthropathies in Patients with Moderate Haemophilia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127527. [PMID: 35742774 PMCID: PMC9223556 DOI: 10.3390/ijerph19127527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 12/10/2022]
Abstract
Some patients with moderate haemophilia (PWMH) report joint damage potentially responsible for gait disorders. Three-dimensional gait analysis (3DGA) is a relevant tool for the identification of complex musculoskeletal impairment. We performed an evaluation with 3DGA of 24 PWMH aged 44.3 ± 16.1 according to their joint status [Haemophilia Joint Health Score (HJHS) < 10 or HJHS ≥ 10] and assessed the correlation with the radiological and clinical parameters. Sixteen had HJHS < 10 (group 1) and eight had HJHS ≥ 10 (group 2). They were compared to 30 healthy subjects of a normative dataset. Both knee and ankle gait variable scores were increased in group 2 compared to the controls (p = 0.02 and p = 0.04, respectively). The PWMH of group 2 had a significant increase in their stance phase, double support duration, and stride width compared to the controls and group 1 (p < 0.01). Very low correlations were found for the ankle gait variable score with the ankle Pettersson sub-score (r2 = 0.250; p = 0.004) and ankle HJHS sub-score (r2 = 0.150; p = 0.04). For the knee, very low correlation was also found between the knee gait variable score and its HJHS sub-score (r2 = 0.290; p < 0.0001). Patients with moderate haemophilia presented a gait alteration in the case of poor lower limb joint status.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport, 44093 Nantes, France
- Correspondence:
| | - Fabien Leboeuf
- Movement-Interactions-Performance (MIP), EA 4334, CHU Nantes, Nantes Université, 44000 Nantes, France; (F.L.); (R.G.)
- School of Health & Society, The University of Salford, Salford M6 6PU, UK
| | - Yves Maugars
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- Service de Rhumatologie, CHU Nantes, Nantes Université, 44000 Nantes, France
| | - Marc Trossaert
- Centre Régional de Traitement de l’Hémophilie, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Pierre Menu
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires-Paris Centre, Groupe Hospitalier Cochin, Assistance Publique—Hôpitaux de Paris, 75014 Paris, France;
| | - Claire Vinatier
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- UFR Odontologie, CHU Nantes, Nantes Université, 44042 Nantes, France
| | - Jérome Guicheux
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- UFR Odontologie, CHU Nantes, Nantes Université, 44042 Nantes, France
- CHU Nantes, PHU4 OTONN, 44093 Nantes, France
| | - Raphael Gross
- Movement-Interactions-Performance (MIP), EA 4334, CHU Nantes, Nantes Université, 44000 Nantes, France; (F.L.); (R.G.)
| | - Marc Dauty
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport, 44093 Nantes, France
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9
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Fouasson-Chailloux A, Menu P, Dauty M. Lower-Limb Arthropathies and Walking: The Use of 3D Gait Analysis as a Relevant Tool in Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116785. [PMID: 35682370 PMCID: PMC9179954 DOI: 10.3390/ijerph19116785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (P.M.); (M.D.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport (IRMS), 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
- Correspondence:
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (P.M.); (M.D.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport (IRMS), 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
| | - Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (P.M.); (M.D.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport (IRMS), 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
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10
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Hmida J, Hilberg T, Ransmann P, Tomschi F, Klein C, Koob S, Franz A, Richter H, Oldenburg J, Strauss AC. Most subjectively affected joints in patients with haemophilia - what has changed after 20 years in Germany? Haemophilia 2022; 28:663-670. [PMID: 35420240 DOI: 10.1111/hae.14564] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with haemophilia (PwH), most frequently affected joints are the ankle, knee and elbow. Due to improved factor therapy in the last decades, these previous findings have to be verified in Germany. AIM The aim of this study is to detect the most affected joint, evaluate the significance of the source of pain and determine the point prevalence of back pain in Germany today. PATIENTS AND METHODS In a retrospective study, data of n = 300 patients with severe moderate and mild haemophilia were evaluated regarding the most affected joint, the most common source of pain, and the point prevalence of back pain. An anamnesis questionnaire and the German Pain Questionnaire were used for this assessment. RESULTS The most affected joint in German PwH is still the ankle (41%), followed by the knee (27%) and the elbow (11%). The most common source of pain is also the ankle joint (32%). Back pain was also identified as one of the most common sources of pain, which is comparable to the elbow (elbow:15%; back:13%). The point prevalence in PwH for back pain was significantly higher compared to the general German population (P = .031). CONCLUSION Our data showed that the ankle is still the most affected joint and the most common source of pain in Germany. These results also showed the relevance of back pain as a pain source. The evaluations also demonstrated the high point prevalence of back pain in PwH. Future therapies should also focus on the spine because joint changes affect posture.
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Affiliation(s)
- Jamil Hmida
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Pia Ransmann
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Fabian Tomschi
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Claudia Klein
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Sebastian Koob
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Alexander Franz
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | | | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Andreas C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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11
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Biomechanical Gait Analysis of an Adult with Severe Hemophilia: A Case Report. Hematol Rep 2022; 14:112-118. [PMID: 35466181 PMCID: PMC9036226 DOI: 10.3390/hematolrep14020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Hemophilia is characterized by recurrent bleeding into the joints leading to irreversible chronic arthropathy with reduced joint range of motion (ROM), which may lead to changes in gait patterns. To analyze the gait pattern in a 35-year-old male with severe hemophilia A, three-dimensional biomechanical analysis was performed during overground walking. The control group data from a public gait dataset of 10 healthy male individuals were used for comparison. The clinical examination was assessed with the Functional Independence Score in Hemophilia (FISH), Haemophilia Activities List (HAL), and Hemophilia Joint Health Score (HJHS). The biomechanical analysis demonstrated a pattern for both left knee and ankle joints with greater similarity to the control group compared to the right knee and ankle joints. ROM based on the HJHS questionnaire also showed greater impairment of the right-side knee joint compared to the left-side knee joint. This unique pattern could be the result of a compensation mechanism due to limited movement during the walking task and the surgical treatment.
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12
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Deniz V, Guzel NA, Lobet S, Antmen AB, Sasmaz HI, Kilci A, Boyraz OC, Gunaştı O, Kurdak SS. Effects of a supervised therapeutic exercise program on musculoskeletal health and gait in patients with haemophilia: A pilot study. Haemophilia 2021; 28:166-175. [PMID: 34687122 DOI: 10.1111/hae.14444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Episodes of bleeding in patients with haemophilia (PwH) are associated with haemophilic arthropathy, limitations in physical performance, reduced quality of life (QoL), and gait disorders. AIM This non-randomized, controlled, interventional, prospective, single-centre pilot study aimed to assess the effects of an 8-week supervised therapeutic exercise program on musculoskeletal health, gait kinematic parameters (GKP), functional capacity, and QoL in adult PwH. METHODS Nineteen PwH were allocated to an exercise group (n = 10) or a control group (n = 9). The patients in the exercise group followed an 8-week supervised therapeutic exercise program. The Haemophilia Joint Health Score (HJHS), a two-dimensional video-based gait kinematic analysis (2D-GKA), the 6-min walking test (6MWT), and the Haemophilia Quality of Life Questionnaire for Adults (Haem-A-Qol) were used as the outcome measures at baseline, after the exercise program (at the 8th week), and at the 6th-month follow-up. RESULTS A significant improvement was observed in the exercise group in the HJHS-Total and Haem-A-Qol Total scores and the 6MWT value after the exercise program. Moreover, the 2D-GKA revealed improvement in most of the GKP (knee extension during the midstance and late swing phases, ankle dorsiflexion during the midstance phase, and ankle plantar flexion during the preswing phase). However, the gain obtained by the exercise program was not maintained at the 6th-month follow-up for the HJHS-Total and Hem-A-QoL-Total scores and GKP. CONCLUSION The 8-week supervised therapeutic exercise program was successful in achieving improvement in joint health, GKP, functional capacity, and QoL in PwH.
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Affiliation(s)
- Volkan Deniz
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | - Nevin Atalay Guzel
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | - Sébastien Lobet
- Service d'hématologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.,Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Brussels, Belgium.,Cliniques universitaires Saint-Luc, Secteur de kinésithérapie, Brussels, Belgium
| | - Ali Bülent Antmen
- Department of Pediatric Hematology and Oncology, Acıbadem Hospital, Adana, Turkey
| | - Hatice Ilgen Sasmaz
- Department of Pediatric Hematology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Abdullah Kilci
- Faculty of Sport Sciences, Çukurova University, Adana, Turkey
| | | | - Ozgür Gunaştı
- Division of Sport Physiology, Department of Physiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sanli Sadi Kurdak
- Division of Sport Physiology, Department of Physiology, Faculty of Medicine, Çukurova University, Adana, Turkey
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13
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Hmida J, Hilberg T, Krüger S, Jansen TR, Goldmann G, Oldenburg J, Wirtz DC, Strauss AC. Changes of static and dynamic spine alignment in patients with severe haemophilia. Haemophilia 2021; 27:e721-e729. [PMID: 34492141 DOI: 10.1111/hae.14406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Haemophilic arthropathy results in a restricted range of motion and pain that often affects gait. The effect of these gait changes on spinal posture has not been studied. AIM To evaluate whether the altered joint situation in patients with haemophilia (PwH) leads to compensatory mechanisms evident in the trunk and spine, considering static and dynamic conditions. METHODS PwH and healthy controls (20-65 years) were examined using rasterstereography in a controlled cohort study. Analysis was performed in static and dynamic conditions in regard to gait phases. Joint status was determined using the Haemophilia Joint Health Score (HJHS). RESULTS Static measurements showed no group differences in PwH (n = 40) compared to healthy controls (n = 40) except pelvic torsion (median [25%-quartile;75%-quartile]: -1.9[-3.2;.9]° vs. .5[-1.1;1.9]°; P = .007). In contrast, under dynamic conditions PwH showed significantly higher trunk inclination and lower apex lumbar lordosis in all gait phases. Additionally, pelvic torsion was increased in mid stance and terminal swing. Considering joint status, PwH had a higher global HJHS (23.5[13.0;30.0] vs. 3.0[1.0;5.0]; P<.001). A significant moderate correlation was shown between the HJHS mobility score and spine parameters (r = .228-.588; P<.05). CONCLUSION Degenerative joint changes in PwH lead to altered spine posture during gait. A reason could be the reduced mobility in the affected joint. Changes in spinal and pelvic posture lead to higher structural burdens; therefore, clinicians should focus on posture of spinal column during gait in daily treatment.
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Affiliation(s)
- Jamil Hmida
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Tom R Jansen
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Georg Goldmann
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Dieter C Wirtz
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Andreas C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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14
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Fouasson-Chailloux A, Maugars Y, Trossaert M, Rannou F, Menu P, Vinatier C, Guicheux J, Dauty M. Isokinetic knee strength deficit in patients with moderate haemophilia. Haemophilia 2021; 27:634-640. [PMID: 33595151 DOI: 10.1111/hae.14279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Knee joint bleedings are responsible for quadriceps atrophy and strength deficit in patients with severe haemophilia. Little is known about patients with moderate haemophilia (PWMH). AIM To evaluate isokinetic quadriceps and hamstrings strength in PWMH and to assess correlation with radiological and clinical parameter. METHODS 18 PWMH aged 37.1 ± 11.4 and 18 healthy age-, weight- and height-matched controls performed a knee isokinetic test at 180°/s to assess quadriceps and hamstrings strength. In the PWMH group, knee Pettersson's score was pursued and Haemophilia Joint Health Score 2.1 (HJHS) was performed to determine unaffected knees (knee HJHS = 0) and affected ones (knee HJHS >0). RESULTS Affected knees had a decrease of quadriceps strength compared to controls, 1.26 ± 0.47 vs 1.64 ± 0.27 Nm/kg and a decrease of hamstring strength, 0.60 ± 0.29 vs 1.03 ± 0.21 Nm/kg, (P < 0.001). Unaffected knees also had a decrease of quadriceps strength compared to controls, 1.36 ± 0.31 vs 1.64 ± 0.27 Nm/kg and a decrease of hamstring strength, 0.69 ± 0.18 vs 1.03 ± 0.21 Nm/kg, (P < 0.001). The conventional hamstring-to-quadriceps ratio was significantly decreased in affected knees compared to controls, 0.46 ± 0.15 vs 0.64 ± 0.13 (P < 0.001) but also in unaffected knees, 0.53 ± 0.16 vs 0.64 ± 0.13 (P = 0.02).No correlation was found between strength and HJHS or Pettersson's score. CONCLUSION PWMH have a significant knee strength deficit, both on the quadriceps and the hamstrings, which is responsible for an important muscle imbalance.
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Affiliation(s)
- Alban Fouasson-Chailloux
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes, France.,Service de Médecine du Sport, CHU Nantes, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France
| | - Yves Maugars
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France.,Service de Rhumatologie, CHU Nantes, Nantes, France
| | - Marc Trossaert
- Centre Régional de Traitement de l'Hémophilie, CHU Nantes, Nantes, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires-Paris Centre, Groupe Hospitalier Cochin, Assistance Publique - Hôpitaux de Paris, France.,INSERM UMRS 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs, UFR Sciences Fondamentales et Biomédicales, Sorbonne Paris Cité, Paris, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes, France.,Service de Médecine du Sport, CHU Nantes, Nantes, France
| | - Claire Vinatier
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France
| | - Jérôme Guicheux
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France.,CHU Nantes, PHU4 OTONN, Nantes, France
| | - Marc Dauty
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes, France.,Service de Médecine du Sport, CHU Nantes, Nantes, France.,Université de Nantes, UFR Odontologie, Nantes, France
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15
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Pasta G, Annunziata S, Polizzi A, Caliogna L, Jannelli E, Minen A, Mosconi M, Benazzo F, Di Minno MND. The Progression of Hemophilic Arthropathy: The Role of Biomarkers. Int J Mol Sci 2020; 21:E7292. [PMID: 33023246 PMCID: PMC7583947 DOI: 10.3390/ijms21197292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hemophilia A and B are X-linked congenital bleeding disorders characterized by recurrent hemarthroses leading to specific changes in the synovium and cartilage, which finally result in the destruction of the joint: this process is called hemophilic arthropathy (HA). This review highlights the most prominent molecular biomarkers found in the literature to discuss their potential use in the clinical practice to monitor bleeding, to assess the progression of the HA and the effectiveness of treatments. METHODS A review of the literature was performed on PubMed and Embase, from 3 to 7 August 2020. Study selection and data extraction were achieved independently by two authors and the following inclusion criteria were determined a priori: English language, available full text and articles published in peer-reviewed journal. In addition, further articles were identified by checking the bibliography of relevant articles and searching for the studies cited in all the articles examined. RESULTS Eligible studies obtained at the end of the search and screen process were seventy-three (73). CONCLUSIONS Despite the surge of interest in the clinical use of biomarkers, current literature underlines the lack of their standardization and their potential use in the clinical practice preserving the role of physical examination and imaging in early diagnosis.
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Affiliation(s)
- Gianluigi Pasta
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Salvatore Annunziata
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Alberto Polizzi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Laura Caliogna
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Eugenio Jannelli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Alessandro Minen
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Mario Mosconi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Francesco Benazzo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
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16
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Eerdekens M, Peerlinck K, Staes F, Pialat JB, Hermans C, Lobet S, Deschamps K. Clinical gait features are associated with MRI findings in patients with haemophilic ankle arthropathy. Haemophilia 2020; 26:333-339. [PMID: 31944497 DOI: 10.1111/hae.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Haemophilic ankle arthropathy due to repeated joint bleeds often leads to altered gait in adult patients with haemophilia. AIM To investigate the association between clinical gait features and blood-induced ankle joint damage scored using MRI findings in patients with haemophilic ankle arthropathy. METHODS This observational study investigated 48 ankles of 24 patients with severe haemophilia (median age of 33 years). Blood-induced ankle joint damage was scored by an experienced radiologist using the International Prophylaxis Study Group (IPSG-)MRI score which evaluates the presence or absence of effusion, synovial hypertrophy, haemosiderin, surface erosions, subchondral cysts and cartilage degeneration. Using 3D gait analysis, peak ankle joint power generation and absorption (W/kg) were measured for each ankle since these are surrogate measures for joint loading during walking. Associations between MRI findings and these two clinical gait features were calculated using Spearman's ρ correlation with an α-level correction (α = 0.01) for multiple tests. RESULTS We found large negative associations between ankle joint peak power generation and IPSG-MRI score (ρ = -0.631; P = <.001), IPSG-MRI osteochondral subscore (ρ = -0.701; P = <.001), severity of synovial hypertrophy (ρ = -0.507; P = <.001) and haemosiderin (ρ = -0.400; P = .005). Associations were also found for ankle joint peak power absorption and IPSG-MRI score (ρ = -0.425; P = .003) and IPSG-MRI osteochondral subscore (ρ = -0.556; P = <.001). CONCLUSION Severe blood-induced ankle joint damage relates to a lowered tolerance towards ankle joint mechanical loading during walking in patients with haemophilia.
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Affiliation(s)
- Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium.,Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, Pellenberg, Belgium.,Haemophilia Center, UZ Leuven, Leuven, Belgium
| | - Kathelijne Peerlinck
- Haemophilia Center, UZ Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Filip Staes
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium
| | - Jean-Baptiste Pialat
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Cédric Hermans
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sébastien Lobet
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Kevin Deschamps
- Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, Pellenberg, Belgium.,Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Brugge, Belgium
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