The dissertation is devoted to the issues of increasing the effectiveness of rehabilitation treatment of patients with hemophilia with knee joint damage
Specific damage to large joints is a characteristic feature that accompanies classical hemophilia and is the main factor in the early disability of patients (Rizzo AR, 2017, Gualtierotti R., 2021). The problem of joint damage in patients with hemophilia is closely related to the inadequacy of replacement hemostatic therapy at the stages of development of hemorrhagic complications, the presence of inhibitory antibodies to f.VIII(IX), the specificity of homeostasis disorders against the background of a deficiency of procoagulant activity of f.VIII(IX) (López-Jiménez JJ., 2019, Chang CY, 2019) The severity of hemophilia also affects the frequency of hemarthroses. The frequency of joint damage increases proportionally to the decrease in the procoagulant activity of f. VIII (IX) (Averyanov E.V., 2021, Hmida J., 2022).
As a rule, hemarthroses affect large joints that bear the greatest mechanical load and are more often injured in the process of the patient's life (Burnaeva S.V., 2019, Bansal Alok, 2023). In severe hemophilia, the onset of hemarthroses may be spontaneous, that is, one that cannot be associated with a previous mechanical injury. At the early stage of the formation of hemophilic arthropathies, inflammation plays a key role, the features of the course of which determine the dynamics of the subsequent pathological process in the joint affected by hemarthrosis (. Views on the nature of the inflammatory process in the joint affected by hemarthrosis remain not finally defined. In most cases, inflammation in the synovial membrane after the development of hemarthrosis is characterized from the standpoint of a nonspecific inflammatory
process (Huang ZY., 2019, Van Vulpen LFD, 2021). At the same time, the severity of inflammation, its factors, and tissue characteristics in the affected area determine the morphological variant of acute or chronic inflammation (Zhang N., 2021). Local hemorrhage is the initial stage of the development of hemophilic arthropathies and is accompanied by an inflammatory process of an exudative-hemorrhagic nature (Buryanov O.A., 2023, Yang J., 2021).
At the current stage of the organization of medical care, treatment inflammatory and degenerative-dystrophic joint lesions in patients with hemophilia includes conservative and orthopedic-surgical methods (Frassanito L., 2019). The basic therapy of any hemorrhagic complications in patients with hemophilia is replacement hemostatic therapy (Goryainova N.V., 2020, Foppen W., 2020). Treatment of acute hemarthroses is carried out symptomatically mainly with the help of transfusions of drugs containing factors VIII (IX) (Starikov A.V., 2019, Di Minno MND, 2021, Barrett MC, 2021).
The lack of effectiveness of conservative and minimally invasive methods of treating chronic synovitis necessitates the use of surgical interventions. At the stage of post-hemorrhagic osteoarthritis, hardware methods are used to eliminate contractures, correcting operations and joint replacement (Park YS., 2018). Orthopedic and surgical interventions at the stage of advanced osteoarthritis are mainly palliative in nature and aimed at increasing the functional activity of the patient. In case of irreversible changes in the joints, the method of total joint replacement is used (Atilla B., 2019, Pathak N., 2020). Despite the high effectiveness of replacement therapy, the widespread use of antibiotics and surgical technologies, surgical interventions in patients with hemophilia continue to maintain a high risk of developing hemorrhagic and purulent-septic complications, are accompanied by prolonged pain syndrome, and require long-term rehabilitation. The timing of the application of therapeutic measures at the stages of progression of hemophilic arthropathy and especially during the period of initial pathological changes in the joints remains undetermined. The resolution of these issues determines the relevance of studying the problem of joint defects in patients with hemophilia, both in theoretical and practical directions.
The purpose of the study is to improve the results of treatment of patients with lesions of the knee joint in hemophilia, by optimizing diagnostics, justifying hemostasis correction, choosing tactics and improving treatment and rehabilitation technology.
