Differing approaches to diagnosis and treatment of musculoskeletal complications of haemophilia in resource-rich and resource-limited settings

Abstract

Management of the musculoskeletal complications of haemophilia should be consistent in both RRS (resource-rich settings) and RLS (resource-limited settings). Due to the lack of available resources in RLS, physicians face challenges that may limit their options for procedures. This article aimed to define the role of different techniques for the management of the musculoskeletal complications of haemophilia in RRS and RLS. A review of recent literature on the topic has been performed. In RLS, ultrasonography can be used as a diagnostic tool instead of MRI; chemical synovectomy can be the first alternative instead of radiosynovectomy and arthroscopic synovectomy; percutaneous treatment of pseudotumours can be performed instead of open surgical removal; finally, autologous cancellous bone can be used to fill cysts and pseudotumours instead of cancellous bone obtained from the Bone Bank. All diagnostic tools and treatments recommended for RLS have been proven to be efficacious; however, the ideal diagnosis and treatment for the musculoskeletal complications of haemophilia in RRS include MRI, radiosynovectomy, arthroscopic knee and ankle debridement in the early stages of arthropathy, total knee arthroplasty and total ankle arthroplasty or ankle fusion (in advanced stages of arthropathy), and surgical removal of pseudotumours. Treatments considered ideal in RRS should be the first therapeutic option if available. However, secondary treatment options that are less costly and therefore more readily available in RLS are perfectly valid and efficacious.