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Biomechanical Determinants and Patterns Associated to the Pathophysiological Cascade of Ankle Arthropathy in Children With Haemophilia: Non-invasive In-vivo Measurement of Foot Joints in Children With Haemophilia During Gait. (3DMKFM)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02229331
Recruitment Status : Unknown
Verified August 2014 by Kevin Deschamps, Universitaire Ziekenhuizen Leuven.
Recruitment status was:  Not yet recruiting
First Posted : September 1, 2014
Last Update Posted : September 1, 2014
Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Information provided by (Responsible Party):
Kevin Deschamps, Universitaire Ziekenhuizen Leuven

Brief Summary:

Haemophilia is a rare X chromosome-linked coagulation disorder resulting from a congenital deficiency or absence of circulating factor VIII (Haemophilia A) or factor IX (Haemophilia B).As a consequence, patients with haemophilia are unable to generate adequate thrombin resulting in abnormal bleeding. Approximately 80-90% of bleeding episodes occur in the musculoskeletal system, especially in the large synovial joints and muscles. Repeated haemarthrosis induce joint cartilage damage and irreversible degenerative joint disease.

Regular intravenous administration of coagulation factor concentrates starting after the first joint bleed and/or before the age of 2 ('primary' prophylaxis) is now the evidence-based, first-choice treatment in children with severe haemophilia. This primary prophylaxis has radically decreased the incidence of arthropathy in patients with haemophilia. Despite the positive effect of primary prophylaxis on arthropathy at several joints, the ankle joint seems to be an exception to the rule, as patients with haemophilia treated with primary prophylaxis still experience ankle arthropathy. As such, the ankle now is the main affected joint in patients with haemophilia under the age of 20. This makes the scientific community facing a new challenge. Determining aetiologic/contributing factors associated to the ankle arthropathy pathophysiological cascade in children with haemophilia (CwH) is therefore a primary objective in the haemophilic research community nowadays.

Loading of the ankle is crucial as the ankle plantar flexors provide the main propulsive power during gait, the tibiotalar joint caries a complex distribution of joint stresses as a consequence of talar morphology and kinematics and, from a biomechanical and biochemical viewpoint, differs significantly from other major lower limb joints. Previous biomechanical studies focused on kinematic and strength measures, however, they omitted to incorporate fundamental measures of joint loading (joint kinetics) and joint structural integrity (JSI, assessment of soft tissue and osteochondral integrity through MRI). This makes it impossible to draw firm conclusions on biomechanical contributing factors. Furthermore, few, low-quality studies focused on conservative treatment strategies (e.g. strength training, mobilisation, proprioceptive training) in patients with ankle arthropathy. In a minority of the cases, important adverse effects (joint bleeding during strength and proprioception training) have been reported. Because of the low quality of the intervention studies and the lack of biomechanical studies focusing on joint loading and joint integrity, it is impossible to pinpoint the aetiology of these side effects. One assumption might be that side effects originate from inappropriate conservative approaches as a consequence of lacking knowledge on joint loading and joint integrity.

An innovative approach within the domain of ankle arthropathy in CwH is therefore to study foot and lower limb kinetics during gait. The quantification of foot joints kinetics encompasses considerable challenges and, until recently, only simplified single-segment foot models have been used. Those models typically underestimate the mechanical contribution of the different foot joints and, of equal importance, overestimate the kinetic contribution of the tibiotalar joint.

To overcome the above mentioned shortcomings, a valid 3D Multisegment Foot Kinetic Model (3DMFKM) should be developed and introduced within the population of CwH. This is important as it allows to quantify increased loading at the tibiotalar joint (or other joints) that may help to explain this ankle arthropathy in these patients. This will have been missed by previous research due to the consideration of the foot as one entire segment.

Providing a classification system based on these kinetic data would, in a second stage, be a pertinent and valuable approach as this provides a rationale for designing randomized controlled trials.

In this perspective, it is also recommended to assess the relationship with other biomechanical and anatomical determinants, especially if one aims at developing optimal management and rehabilitation strategies.

Condition or disease Intervention/treatment
Haemophilia Arthropathy Other: Gait analysis

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Study Type : Observational
Estimated Enrollment : 70 participants
Observational Model: Cohort
Time Perspective: Cross-Sectional
Official Title: Biomechanical Determinants and Patterns Associated to the Pathophysiological Cascade of Ankle Arthropathy in Children With Haemophilia: Non-invasive In-vivo Measurement of Foot Joints in Children With Haemophilia During Gait.
Study Start Date : September 2014
Estimated Primary Completion Date : September 2014
Estimated Study Completion Date : September 2016

Resource links provided by the National Library of Medicine

Group/Cohort Intervention/treatment
gait analysis
gait analysis
Other: Gait analysis

Primary Outcome Measures :
  1. Kinetic Joint Classification System outcome measure [ Time Frame: month 24 ]
    Kinetic Joint classification system encompasses a classification system based on mechanical loading profiles of foot joints measured during barefoot walking

Secondary Outcome Measures :
  1. Instrumentation implementation outcome measure [ Time Frame: month 12 ]
    Before the Kinetic Joint Classification System can be developed, a number of technical challenges needs to be tackled. Thus, this outcome measure reflects the adequate implementation of measurement technology for assessing gait pattern and mechanical loading of foot joints during walking

  2. MRI and Haemophilia Joint Health Score correlation outcome measure [ Time Frame: month 24 ]

Information from the National Library of Medicine

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Ages Eligible for Study:   6 Years to 18 Years   (Child, Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   Yes
Sampling Method:   Probability Sample
Study Population
Children with haemophilia

Inclusion Criteria:

  • Aged range 6-18 years
  • All levels of severity of haemophilia A or B, and on all types of treatment.

Exclusion Criteria:

  • Excluded will be those with an acute bleed within 12 weeks prior to testing and those with an uncontrolled high titre inhibitor.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02229331

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Contact: Kevin Deschamps, Dr +32 477 206 847

Sponsors and Collaborators
Universitaire Ziekenhuizen Leuven
Cliniques universitaires Saint-Luc- Université Catholique de Louvain
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Responsible Party: Kevin Deschamps, Dr, Universitaire Ziekenhuizen Leuven Identifier: NCT02229331    
Other Study ID Numbers: 3DMKFM_haemo1
First Posted: September 1, 2014    Key Record Dates
Last Update Posted: September 1, 2014
Last Verified: August 2014
Keywords provided by Kevin Deschamps, Universitaire Ziekenhuizen Leuven:
Additional relevant MeSH terms:
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Joint Diseases
Hemophilia A
Blood Coagulation Disorders, Inherited
Blood Coagulation Disorders
Hematologic Diseases
Coagulation Protein Disorders
Hemorrhagic Disorders
Genetic Diseases, Inborn
Musculoskeletal Diseases