Radiographic features of hemophilia most commonly occur where?

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Recurrent bleeding into joints leads to hemophilic arthropathy, and the knee is the joint most prone to showing radiographic changes because it is large, weight-bearing, and has a substantial synovial cavity that readily accumulates blood. Over time, repeated hemarthroses cause chronic synovitis with cartilage and bone damage. On X-ray, the knee typically shows a progression from subtle early findings to more definite changes: joint space narrowing, irregular and eroded articular surfaces, subchondral cysts, and marginal osteophyte formation, often with deformities of the distal femur and proximal tibia. Soft-tissue swelling may be present, and in children growth disturbances can occur if the epiphyses are repeatedly affected. While the elbow, wrist, and ankle can also be affected, the knee most commonly exhibits radiographic features due to its size and tendency to accumulate repeated bleeds; hip involvement is less common radiographically because hip bleeds are less frequent and harder to detect early on.