Background: Hip hemarthrosis in patients with hemophilia are rare. Due to hip anatomy, the associated increased intracapsular pressure can compromise femoral head perfusion, resulting in avascular necrosis (AVN). Unfortunately, typical imaging may miss early hypoperfusion. Conventional treatment includes intravenous factor infusion, bed rest, and pain control. Arthrocentesis is controversial.

Aims: We present a case of hip hemarthrosis in a patient with hemophilia A that highlights the novel use of bone scan with single photon emission computed tomography (SPECT) for early detection of femoral head ischemia, and the possible role of arthrocentesis in management.

Methods: .

Results: Case: Thirteen-year-old male with hemophilia A presented with hip pain. US detected a hip hemarthrosis. He remained unresponsive to typical treatment. Bone scan with SPECT revealed femoral head hypoperfusion. The patient underwent arthrocentesis and experienced immediate symptom improvement. Repeat bone scan with SPECT demonstrated increased blood flow to the affected femoral head.
Discussion: Nuclear medicine imaging may help detect early ischemic changes in hip hemarthrosis. Bone scan with SPECT in our patient allowed for early identification of hypoperfusion and procedural intervention, which normalized femoral head perfusion. It is possible that decreased perfusion can be identified early with the use of this imaging, creating the opportunity to intervene and prevent adverse outcomes.
Our case also demonstrates the utility of arthrocentesis for hip hemarthrosis that are unresponsive to conventional treatment. This can provide immediate symptom relief, improved profusion, and an expedited recovery. There have been no documented adverse outcomes with this procedure.

Conclusions: Management of hip hemarthrosis in patients with hemophilia should be expedited to prevent morbidity. If there is no clinical improvement after 24-48 hours of treatment, arthrocentesis should be considered, with appropriate factor replacement therapy. We also encourage the consideration of medical imaging to assess femoral head perfusion, particularly in cases with severe or unresponsive symptoms, or large joint effusions.

« Back to ISTH 2021 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/use-of-single-photon-emission-computed-tomography-and-arthrocentesis-in-the-management-of-hip-hemarthrosis-in-hemophilia-a/