Arnold and Hilgartner described stages of progression in a joint affected by hemophilic arthropathy. The authors are from the New York Hospital for Special Surgery and Cornell Medical Center in New York City.
Parameters seen on the joint radiograph:
(1) soft tissue changes secondary to hemarthroses or bleeding into the soft tissue adjacent to the joint
(2) bone changes
(3) cartilage and joint changes
Soft Tissue Changes
Bone Changes
Cartilage and Joint Changes
Stage
none
none
none
0
present
none
none
I
NA
osteoporosis; overgrowth of epiphyses; no bone cysts
no narrowing of cartilage space; integrity of joint maintained
II
synovium may be opacified from hemosiderin deposits
early subchondral bone cysts; squaring of patella; inter-condylar notch of distal femur or trochlear notch of the ulna widened
no significant narrowing of joint space; joint shows signs of disorganization
III
NA
progression of bone changes in Stage III
joint space narrowed with destruction of cartilage
IV
NA
marked enlargement of epiphysis
fibrous joint contracture; loss of joint space; absence of articular cartilage; joint very disorganized
V
Stage II corresponds to clinical subacute arthropathy.
Stage III is potentially reversible with treatment.
Stage V is associated with marked restriction in the joint's range of motion.
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