Haemophilic arthropathy of the knee: a surgeon's nightmare

Abstract

Surgical management of knee synovitis secondary to mild haemophilia, without any significant previous medical history and an adverse family history of haematological disorders, is arduous. Due to its rare occurrence, the diagnosis is often delayed or sometimes missed, leading to the grave and often lethal consequences in intraoperative and postoperative periods. Hardly isolated knee arthropathy due to mild haemophilia has been reported in the available literature. In this report, we present the management of a case of a 16-year-old male with isolated knee synovitis with undiagnosed mild haemophilia, who came to us with the first episode of knee bleeding. We elucidate the signs and symptoms, investigations, surgical management, and difficulties faced, especially during the postoperative period. This case report is presented to enhance awareness of the existence of this disorder and its management to prevent postoperative complications.

Keywords: Diagnostic delay; arthropathy knee; mild haemophilia.

Figure 1

Showing diffuse swelling around the left knee (A) and an X-ray of knee anteroposterior and lateral view suggesting prominent soft tissue shadow, widening of intercondylar notch and areas of cortical scalloping suggesting chronic compressing changes (B).

Figure 2

Intraoperative photographs show chondral erosions of the medial femoral condyle (A). Synovium was removed during the surgical procedure (B). H&E stained section taken from the synovial layer of the knee joint shows proliferation of the synovial layer along with deposition of hemosiderin pigment and mild lymphocytic infiltration (C).

Figure 3

Clinical photograph on the first day of surgery depicting diffuse swelling, oedema of skin and ooze of blood (A). 3^rd Postoperative day photograph shows a further increase in swelling, superficial blackening of the skin, and oozing of blood (B). 10^th-day showing superficial necrosis of skin with cessation of bleeding (C). 20^th day showing ulceration of the skin, the disappearance of oedema and blackening of skin (D).