The Safety of Extracorporeal Shockwave Therapy in Hemophilic Arthropathy

Abstract

\n BackgroundThe hemophilic arthropathy was caused by repeated joint bleeding, which resulted in joint synovium hyperplasia, cartilage damage and bone deformity. Extracorporeal shockwave treatment (ESWT) is a non-invasive treatment with high safety and has been widely used in the treatment of various musculoskeletal conditions. This study was aimed to evaluate the safety of ESWT in hemophilic arthropathy of the knee.MethodsThis is a prospective single blind randomized control study conducted between 2019/08/01 and 2020/07/31. Hemophilia and Von Willebrand disease patients were enrolled and randomized for extracorporeal shock wave therapy to the left or right knee joint and energy-free sham therapy to the other knee joint at the 1st and 2nd month after prophylactic coagulation factor administration. As safety evaluation, hemophilia joint health score (HJHS), knee score scale (KSS), visual analog scale (VAS) and ultrasound (HEAD-US) were checked at the beginning, 1st, 2nd, 3rd and 6th month. Knee MRI was examined at the beginning and 6th month.ResultsHJHS score of the knee receiving real ESWT did not elevate in 9 patients (75%). KSS demonstrated neither significant improvement nor deterioration after ESWT. VAS declined after two sessions of ESWT. Ultrasound and MRI showed no breakthrough joint bleeding nor progression of previously existed effusion and hemarthrosis.ConclusionESWT might be a safe treatment for hemophilic arthropathy once prophylactic coagulation factors are adequately administrated before ESWT. Further well-controlled study enrolling more hemophilia patients might be needed for the effectiveness of ESWT on these patients.