A clinical score for hemophilic arthropathy can be based on the physical examination. This was developed by the Orthopedic Advisory Committee of the World Federation of Hemophilia.
Parameters:
(1) swelling
(2) muscle atrophy
(3) axial deformity
(4) crepitus on motion
(5) range of motion
(6) flexion contracture
(7) instability
|
Parameter |
Finding |
Points |
|
swelling |
none |
0 |
|
|
present |
2 |
|
|
present with chronic synovitis |
2S |
|
muscle atrophy |
none |
0 |
|
|
minimal (< 1 cm decrease in circumference) |
0 |
|
|
present |
1 |
|
axial deformity (knee or ankle only) |
normal |
0 |
|
|
mild varus or valgus deformity (see below) |
1 |
|
|
moderate to marked varus or valgus deformity (see below) |
2 |
|
crepitus on motion |
none |
0 |
|
|
present |
1 |
|
range of motion |
0-9% loss in full range of motion |
0 |
|
|
10-33.33% loss in full range of motion |
1 |
|
|
> 33.33% loss in full range of motion |
2 |
|
flexion contracture (hip, knee or ankle only) |
0-14° fixed flexion contracture |
0 |
|
|
>= 15° fixed flexion contracture in hip or knee; equinus at ankle |
2 |
|
instability |
none |
0 |
|
|
noted on examination but does not interfere with function and does not require bracing |
1 |
|
|
instability that creates a functional defect or that requires bracing |
2 |
where:
• Muscle atrophy appears to be based on decrease in the circumference of the adjacent limb.
• The instructions for axial deformity are given in Table 5, Gilbert (1993), page 5. The table as written appears to contain a typographic error ("8-15° varus or 0-5° varus" for mild deformity of the knee; "<= 10° varus or <= 5° varus" for mild deformity of the ankle). One of the options should be valgus.
• Instructions on measuring the full range of motion of the different joints is given on Gilbert (1993), page 5. Full range of motion: flexion of knee 135°; full plantar and dorsal flexion of ankle 70°; flexion of elbow 150°; full supination and pronation of forearm 180°.
physical examination score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12 for knee or ankle; 10 for hip; 8 for other joints
• A score of 0 indicates a normal joint.
• A score of 12 indicates a maximally affected joint.
Specialty: Surgery, orthopedic
