Silent progression of hemophilic arthropathy of the elbow: case reports of three pediatric patients

We present three pediatric cases of hemophilic arthropathy (HA) of the elbow that had already progressed to advanced stage with osteochondral lesions at the time of diagnosis-Case 1: 13-year-old boy, severe hemophilia A; Case 2: 13-year-old boy, moderate hemophilia A; Case 3: 15-year-old boy, severe hemophilia A. HA results from repeated hemarthrosis. Notably, Cases 2 and 3 had no history of clinically recognized elbow hemarthrosis before HA diagnosis, and Case 1 had only two episodes of hemarthrosis. Cases 2 and 3 did not report elbow extension restriction and pain for 1 or 2 years, as their daily lives were minimally affected. Since full elbow extension or flexion is rarely needed in daily life, and restricted elbow motion can be compensated by other motions, leading to less inconvenience. Consequently, HA of the elbow often remains unnoticed until it progresses to advanced stage; which necessitates careful monitoring from childhood.