Hemophilia x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2], Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[3]

Overview

An x-ray of the joints in the case of hemophilic arthropathy may be helpful in the diagnosis of hemophilia. Pettersson scoring system, designed in 1980, is widely applied for the classification of osteo-chondral changes of hemophilic arthropathy in elbows, knees, and ankles. This scoring system is based on typical findings of hemophilic arthropathy on posterior-anterior and lateral x-rays. Arnold-Hilgartner classification is also a plain radiograph grading system for hemophilic arthropathy.

X Ray

• An x-ray of the joints in the case of hemophilic arthropathy may be helpful in the diagnosis of hemophilia.
• Pettersson scoring system, designed in 1980 and based on typical findings of hemophilic arthropathy on posterior-anterior and lateral x-rays, is widely applied for the classification of osteo-chondral changes of hemophilic arthropathy.

X-ray showing hemophilic arthropathy with moderate effusion, decreased joint space, subchondral erosions, and the physis is narrow compared to the other knee. The intercondylar notch is irregular and wide. .Source: Case courtesy of Dr Abdallah Al Khateeb , Radiopaedia.org, rID: 45521

Classification of hemophilic arthropathy according to the Pettersson score

Finding	Interpretation
Osteoporosis	Absent = 0 Present = 1
Enlargement of epiphysis	Absent = 0 Present = 1
Irregularity of subchondral surface	Absent = 0 Partially involved = 1 Totally involved = 2
Narrowing of joint space	Absent = 0 Joint space > 1 mm = 1 Joint space < 1 mm = 2
Subchondral cysts formation	Absent = 0 1 cyst = 1 >1 cyst = 2
Erosion of joint margins	Absent = 0 Present = 1
Gross incongruence of articulating bone ends	Absent = 0 Slight = 1 Pronounced = 2
Joint deformity (angulation and/or displacement)	Absent = 0 Slight = 1 Pronounced = 2

Arnold-Hilgartner scale of hemophilic arthropathy

Stage	Findings
Stage 0	Normal joint
Stage I	No skeletal abnormalities Soft-tissue swelling is present
Stage II	Osteoporosis and overgrowth of the epiphysis No cysts No narrowing of the cartilage space
Stage III	Early subchondral bone cysts Squaring of the patella Widened notch of the distal femur or humerus Preservation of the cartilage space
Stage IV	Findings of stage III, but more advanced; narrowed cartilage space
Stage V	Fibrous joint contractures Loss of the joint cartilage space Extensive enlargement of the epiphyses with substantial disorganization of the joint