Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

Abstract

Total knee arthroplasty (TKA) is a commonly used option in advanced stages of knee arthropathy in people with hemophilia (PWH). The objective of this article is to determine what the complication rates and implant survival rates in PWH are in the literature. A literature search was carried out in PubMed (MEDLINE), Cochrane Library, Web of Science, Embase and Google Scholar utilizing the keywords “hemophilia TKA complications” on 20 October 2022. It was found that the rate of complications after TKA in PWH is high (range 7% to 30%), although it has improved during the last two decades, possibly due to better perioperative hematologic treatment. However, prosthetic survival at 10 years has not changed substantially, being in the last 30 years approximately 80% to 90% taking as endpoint the revision for any reason. Survival at 20 years taking as endpoint the revision for any reason is 60%. It is possible that with a precise perioperative control of hemostasis in PWH, the percentage of complications after TKA can be diminished.

Successful transfemoral prosthesis in a patient with haemophilia A and factor VIII inhibitors: A case report

“…However, several studies have documented the importance of multidisciplinary care and appropriate prophylaxis in achieving successful surgical outcomes in the management of haemophilic arthropathy in patients with inhibitors. 10,11 Our case report is novel, in that it showcases the successful and complication-free implementation of a transfemoral prosthesis in a patient with severe haemophilia A and inhibitors. Moreover, our successful outcome is consistent with findings from another study that reported low rates of complications in patients with bleeding disorders undergoing major surgeries at a haemophilia treatment center.…”

A Retrospective, Long‐term Follow‐up of the Clinical Outcomes and Cost‐effectiveness of Single‐anesthetic Multiple Total Joint Procedures in Hemophilic Arthropathy

“…The revision rate was 3.70% (3/81) for all TKAs of three groups due to deep infection and aseptic prosthetic loosening in our study. A previous review reported the total complication rate in TKA of hemophilia patients to range between 7% and 30% 14 . However, the rate has decreased within the last two decades due to enhanced perioperative hematologic treatment 14 .…”

“…A previous review reported the total complication rate in TKA of hemophilia patients to range between 7% and 30% 14 . However, the rate has decreased within the last two decades due to enhanced perioperative hematologic treatment 14 . Another study further showed that 34% of their patients suffered from postoperative major bleeding, which significantly led to worse functional outcomes and a high complication rate in TKA of hemophilia patients 15 .…”

“…14 However, the rate has decreased within the last two decades due to enhanced perioperative hematologic treatment. 14 Another study further showed that 34% of their patients suffered from postoperative major bleeding, which significantly led to worse functional outcomes and a high complication rate in TKA of hemophilia patients. 15 Furthermore, aseptic loosening after THA is one of the most common complications.…”