Point-of-care musculoskeletal ultrasound in hemophilic arthropathy: Evidence synthesis, clinical impact, and recommendations for multidisciplinary implementation

Abstract Objective: To synthesize and critically evaluate the existing body of evidence on the diagnostic performance, clinical integration, and multidisciplinary implementation of point-of-care musculoskeletal ultrasound (POCUS) in the management of hemophilic arthropathy (HA). This review aims to clarify its comparative utility alongside gold-standard modalities (e.g., MRI), explore its impact on therapeutic decision-making across specialties, and generate practical, evidence-based recommendations to guide future clinical practice, education, and research agendas in hematologic care. Methods: A targeted narrative review was conducted of over 100 peer-reviewed studies published between 2000 and 2025 that assess the use of musculoskeletal ultrasound, specifically POCUS, in the context of hemophilic joint disease. Extracted data encompassed diagnostic sensitivity and specificity, correlation with MRI and standardized clinical assessments (e.g., Haemophilia Joint Health Score—HJHS), validation and uptake of ultrasound protocols (HEAD-US, JADE, HEAD-US-C), role delineation among providers (hematologists, physiatrists, radiologists), patient-reported outcome measures (PROs), training frameworks, and methodological limitations across the literature. Emphasis was placed on identifying implementation barriers, gaps in longitudinal monitoring, and disparities in access—particularly within pediatric and resource-limited settings. This review was also informed by long-term community engagement and service within bleeding disorder populations, offering patient-centered context to guide implementation recommendations. Summary of Results: POCUS demonstrates high sensitivity for detecting early joint pathology (synovitis, effusions, osteochondral changes) and acute hemarthrosis, enabling rapid bedside decision-making. While MRI remains superior for deep cartilage evaluation and hemosiderin detection, ultrasound correlates strongly with MRI and clinical scores, often revealing subclinical findings not evident on physical exam. Validated ultrasound protocols like HEAD-US (semi-quantitative), JADE (quantitative), HEAD-US-C (adds effusion, vascularity), and simplified universal approaches all support consistent assessment across settings. HEAD-US offers speed and accessibility for non-specialists, while JADE allows detailed longitudinal monitoring. However, standardization remains incomplete—especially in pediatrics. POCUS significantly influences physical therapy decisions, informing tailored interventions (exercise adjustments, manual therapy, bracing) and identifying subclinical bleeding that impacts management plans. Hematologists use ultrasound for acute joint assessment and procedural guidance (aspiration, injections); radiologists typically handle protocol oversight and complex diagnostics. Integrated multidisciplinary models optimize outcomes and workflow efficiency. Ultrasound visualization enhances patient understanding, engagement, adherence, and shared decision-making, although direct quantitative improvements in QoL from ultrasound-guided management remain under-studied. Studies commonly reported small sample sizes, single-center designs, cross-sectional methodologies, lack of longitudinal tracking, inconsistent use of PROs, and absence of universal standards—highlighting significant research gaps in early detection and intervention—which are critical to preventing irreversible joint damage and long-term disability in individuals with hemophilia. Conclusions: POCUS offers substantial clinical value for early diagnosis, real-time decision-making, and personalized therapy in HA. Recommendations include routine integration of standardized ultrasound protocols (HEAD-US, JADE), comprehensive training programs for multidisciplinary providers, and incorporation of PROs into joint monitoring. Future research should prioritize multicenter, longitudinal studies to validate protocols and evaluate cost-effectiveness to outcomes and equitable access to care. In parallel, translational work should focus on harmonizing imaging with emerging biomarkers of joint health and integrating POCUS into digital care pathways, thereby establishing it as a core tool in precision hematologic rehabilitation.