Cartilage degeneration in hemophilic arthropathy: to focus on prevention or regeneration?

Introduction: One of the problems that remain unsolved in people with hemophilia (PwH) is how to regenerate articular cartilage.

Areas covered: In this article, we have reviewed the existing information on articular cartilage regeneration in the general population and in PwH. In the general population, it has been reported that the clinical results of different types of commercial products are better than those of microfractures and that the results of products that combined microfractures and allograft products are better than those of autologous chondrocyte products. In PwH iron chelators, anti-inflammatory drugs, and anti-fibrinolytics drugs have shown beneficial effects, predominantly in preclinical studies. Hemarthrosis models have shown that mesenchymal stem cells (MSCs) intraarticular injections have some beneficial effects on cartilage structure and function. An in vitro preliminary study has highlighted the opportunity of using hemophilic chondrocytes for autologous cartilage implants in PwH. In a clinical study, bone marrow-derived cells transplantation (BMDCT) seemed to be a promising regenerative treatment for osteochondral lesions in mild ankle hemophilic arthropathy in PwH.

Expert opinion: Today it is not possible to regenerate articular cartilage. It is essential to perform primary hematologic prophylaxis throughout the life of PwH to prevent the articular cartilage from degeneration.