Hemophilic arthropathy

This is a patient who presents with chronic ankle pain. Frontal and lateral radiographs of the ankle were obtained. The red arrows on the frontal radiograph demonstrate severe narrowing of the tibiotalar joint space. There is subchondral sclerosis, osteophyte formation, and large subchondral cyst formation indicative of advanced osteoarthritis. The lateral radiograph demonstrates similar findings. However, the ankle is a joint which is not typically associated with severe secondary osteoarthritis unless there is a predisposing disease condition or event. Differential considerations would include severe secondary osteoarthritis due to trauma, septic arthritis, neurogenic arthropathy, or hemophilia. The diagnosis in this case is hemophilic arthropathy. Hemophilia occurs in male patients who get recurrent hemarthroses which eventually leads to severe secondary osteoarthritis.