Ultrasound-guided joint procedures in hemophilia: technique, indications and tips

ABSTRACT

Introduction

The therapeutic approach to pain in hemophilia should be multimodal. Intra-articular injections are a good option when joint lesions do not respond to hematological treatment or rehabilitation and orthopedic surgery is not yet indicated. Performing these procedures under ultrasound guidance has been shown to improve their accuracy and efficacy.

Areas covered

This article provides a practical overview of the most frequently employed ultrasound-guided intra-articular procedures on the joints of people with hemophilia. The article describes the key elements for performing the technique on the elbow, knee and ankle as the most affected joints. The particularities of the most frequent indications, arthrocentesis, synoviorthesis and analgesic injections with various products are detailed.

Expert opinion

Current hematological treatments have made it possible to incorporate new therapeutic tools for pain relief for people with hemophilia, including ultrasound-guided joint injections, which offer excellent results.

KEYWORDS:

• Hemophilia
• ultrasound-guided injections
• indications
• technique
• synoviorthesis

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Article highlights

• Intra-articular injections are another alternative to improve pain and function in PWH. Patient information and team coordination are essential for their performance. The technique should always be performed under hemostatic cover and sterile conditions.

• Intra-articular injections are applied to hemophilia-specific processes such as hemarthrosis, chronic synovitis and painful arthropathy and aim to relieve pain, restore function and facilitate the performance of activities of daily living.

• Ultrasound guidance helps ensure intra-articular placement of the needle tip while minimizing periarticular soft tissue injury.

• Good planning and careful technique before, during and after the procedure are essential to facilitate safe and successful ultrasound-guided joint injection. It is important to consider the best invasive approach, taking into account the needle path and target depth.

• In patients with advanced arthropathy and osteophytes, out-of-plane needle visualization access might be preferable. These shorter and more precise approaches will also be preferable in case of synovitis or critical neurovascular structures that need to be protected.

• The most recommended intra-articular procedures are arthrocentesis, radiosynovectomies and analgesic injections with various drugs; their indication depends on the specific joint problem.

Declaration of interest

H De la Corte-Rodriguez has received honoraria for attending symposia/congresses, speaking, consulting, and/or funds for research from Pfizer, Roche, Sobi, Novo Nordisk, Takeda, Bayer, and CSL Behring. MT Alvarez-Roman has received honoraria for attending symposia/congresses, speaking, consulting, and/or research funds from Bayer, CSL Behring, Grifols, Novo Nordisk, Octapharma, Pfizer, Roche, Sobi, Amgen, Novartis, and Takeda. V Jimenez-Yuste has received honoraria for attending symposia/congresses, speaking, consulting, and/or funds for research from Takeda, Bayer, Biomarin, Sanofi, CSL Behring, Grifols, Novo Nordisk, Sobi, Roche, Octapharma, and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.