Severe hemophilia patients are often affected by joint degeneration which can lead to postural changes during gait, a new article published in Haemophilia suggests.

In the study, all patients with hemophilia had significantly worse (P <.001) Hemophilia Joint Health Scores (HJHS) compared to controls, which led to compensatory movements during the dynamic portions of gait.

During different gait portions, significant differences were observed in the apex lumbar lordosis, pelvic torsion, and trunk inclination. Patients with hemophilia also had a significantly lower deviation in apex lumbar lordosis than the controls during all phases of gait.


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In contrast to dynamic gait measurements, only pelvic torsion was significantly different between groups during static posture measurements (P =.007).

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“The differences in spine changes only became apparent in dynamic measurements, which emphasizes the need to carry out dynamic measurements,” the authors noted. This could have important implications given that “clinical examination of the spine is usually performed statically,” according to the authors.

In addition to having significantly higher HJHS values, patients with hemophilia also had a significantly higher score on the total visual analog scale (VAS) of pain (P <.001) compared to the control group. Only 3 of the 6 individual joints investigated had significantly higher VAS values, however.

In all gait phases, a significant correlation (P <.01) was found between trunk inclination and HJHS (Spearman’s rank correlation, r =.303-.4362) as well as apex lumbar lordosis and HJHS (P <.001; r =.382-.466). HJHS also correlated with pelvic torsion during midstance of gait (P <.001; r =-.588).

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No significant correlation was seen between VAS scores and gait parameters except for pelvic torsion during midstance and terminal swing (P <.001; r =-.418 and P =.029; r =.244, respectively). 

Based on these results the authors suggested, “The cause of higher trunk inclination, pelvis torsion and lower apex lumbar lordosis in our study was primarily seen in weak joint mobility rather than acute pain due to a lack of correlation between spinal parameters and VAS. Therefore, we assumed that spinal posture was mainly dependent on joint mobility.”

During the study, a total of 40 patients with severe hemophilia (35 with hemophilia A and 5 with hemophilia B) and 40 healthy controls were compared. Rasterstereography was used to make measurements of the spine during stance and gait and an integrated pressure plate on a treadmill was utilized to correlate spinal position with gait phases.

Reference

Hmida J, Hilberg T, Krüger S, et al. Changes of static and dynamic spine alignment in patients with severe haemophilia. Haemophilia. 2021;(hae.14406). doi:10.1111/hae.14406