Utility of Knee Ultrasound in Management of Patients with Hemophilia in a Limited Resource Setting

Hemophilia is among the diseases that have not received adequate attention from the critical health decision-makers, despite the increasing number of patients diagnosed with the disease locally and across the world. Among the patients with hemophilia, bleeding into the joints, principally the knee joint, is common. A timely diagnosis of hemarthrosis and its complications is critical in optimal care for patients with hemophilia. MRI is the gold standard for the joint assessment in hemophilia, but access to MRI is limited by cost and scarcity. Ultrasonography is a valuable alternative, but the use of musculoskeletal sonography is not widespread locally. This study was designed to assess the utility of ultrasound in the assessment of the knee joint of patients with hemophilia who presented with knee pain or knee swelling at the hemophilia clinic in a hospital in Nairobi. A cross-sectional descriptive study was conducted over a period of four months from February 2021 to April 2021 at the National Hemophilia Clinic in a hospital Nairobi. Both clinical assessment of the knee and sonographic assessment of the knees was done, and results recorded in the data collection form. The mean age of the participants was 18.1 years (SD ± 11.8) with an age range between 3 and 60 years. The most common age group was 10-19 years that comprised 49% of the study population. Specific knee pathologies were identified by ultrasound in 88% of the participants, and there were both soft tissues and bony changes. Synovial hypertrophy was noted in 66% of the participants, hemarthrosis was seen in 51%, bone erosions 49%, articular cartilage thinning was seen in 39%, and subchondral cysts in 34%. The use of ultrasound for scanning patients presenting in hemophilia clinics with joint pain or swelling provides important imaging information about the status of the joints that can guide in management.