X-Ray Diagnostics of Femoral Head Destruction in Patients with Hemophilia A

Abstract

Hemophilia A is a hereditary coagulation disorder that often leads to recurrent haemarthroses and progressive joint destruction, particularly in weight-bearing joints such as the hip. This study aims to evaluate the diagnostic capabilities of conventional X-ray imaging in detecting femoral head destruction in patients with Hemophilia A. A total of 36 male patients aged 12–45 years with moderate to severe Hemophilia A underwent standard anteroposterior pelvic radiographs. Radiological findings were assessed using the Arnold–Hilgartner classification and correlated with clinical data. The majority of patients exhibited Grade III or higher arthropathy, with common features including joint space narrowing, subchondral cysts, and femoral head flattening. A significant correlation was found between disease duration and severity of radiographic damage. The study confirms the continued relevance of X-ray imaging as an accessible, cost-effective method for assessing joint degeneration in hemophilia, especially in resource-limited settings.

Introduction

Hemophilia A is a genetic bleeding disorder caused by a deficiency of clotting factor VIII, often leading to joint bleeding (haemarthroses), particularly in the hip joint, which can result in progressive femoral head destruction. Early diagnosis is essential to prevent irreversible joint damage and functional impairment. While MRI and CT offer detailed imaging, X-rays remain the most accessible and widely used tool, especially in low-resource settings.

This cross-sectional study evaluated the effectiveness of conventional X-ray imaging in diagnosing femoral head damage in 36 male patients (ages 12–45) with moderate to severe Hemophilia A. Using the Arnold–Hilgartner scale, radiographs were analyzed to identify joint degeneration features like joint space narrowing, femoral head flattening, subchondral cysts, and osteoporosis.

Key Findings:

• Severity distribution (Arnold–Hilgartner grades):

  • Grade I–II: 10 patients (27.7%)

  • Grade III–V: 26 patients (72.3%)

• Most common radiographic features:

  • Joint space narrowing: 75%

  • Femoral head flattening: 58.3%

  • Periarticular osteoporosis: 69.4%

• Correlations:

  • Disease duration and frequency of haemarthroses were strongly correlated with radiographic severity (r = 0.71 and 0.66, respectively; p < 0.01).

  • Greater joint destruction was associated with decreased function and increased pain.

• Interobserver agreement on radiographic grading was high (Cohen’s kappa = 0.82), showing strong reliability.

Discussion:

Despite its limitations in early detection and soft tissue assessment, X-ray imaging effectively identifies advanced joint damage and correlates well with clinical symptoms in hemophilic patients. It is especially valuable in tracking disease progression where advanced imaging or prophylactic treatment is limited. The study underscores the cumulative damage caused by repeated bleeding episodes and the importance of early intervention.

Conclusion

Conventional X-ray is a practical, cost-effective, and reliable tool for diagnosing femoral head destruction in Hemophilia A, especially in resource-limited environments. The findings support its continued use for disease monitoring and clinical decision-making, while also advocating for better access to prophylactic therapies and imaging services. Future research should explore integrated clinical-radiological scoring systems and longitudinal monitoring to improve patient outcomes.

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Copyright

Copyright © 2025 Vakhidov Feruz Faezovich, Joniev Khoshim Dulanovich, Madasheva Anajan Gazkhanovna. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.