Factors influencing the long‐term outcome of primary total knee replacement in haemophiliacs: a review of 116 procedures at a single institution

Abstract

Summary Total knee replacement (TKR) is a safe treatment for alleviating pain and restoring physical function in end‐stage arthropathy of the knee. First reports of TKR in haemophiliacs date back to the mid‐1970s, however detailed information on long‐term outcome is scarce. This study evaluated factors influencing the outcome of 116 primary TKRs performed consecutively over 14 years at a single institution. Haemostatic management is discussed in patients with and without inhibitors. Orthopaedic outcome was measured by using the Hospital for Special Surgery knee‐rating scale, knee flexion contracture and range of motion. At the end of follow‐up period (median duration: 5·1 years) 96 prostheses (83%) were still in place with a 7‐year removal‐free survival of 81%, similar between human immunodeficiency virus‐positive and ‐negative patients and lower in inhibitor than non‐inhibitor patients (44% vs. 87%; P < 0·05). Sixteen prostheses (14%) were removed for infection (nine) or aseptic loosening (seven) after a median of 4·5 years. Presence of inhibitors, continuous infusion, cementless prostheses and different primary surgeons were associated with an increased risk of infection; however, after adjustment, only primary surgeon was confirmed as an independent risk factor. These results show that TKR represents a safe and effective procedure in haemophiliacs if performed by a highly experienced surgeon.

Physical and psychosocial challenges in adult hemophilia patients with inhibitors

“…Orthopedic procedures have become an increasingly important option to improve mobility and quality of life (QoL) in the inhibitor population;30–32 however, the benefits and risks should be determined on an individual basis. A comprehensive approach by the hemophilia care team to manage expectations for surgical improvement of orthopedic status in patients with inhibitors is imperative to optimize the outcome.…”

How I treat age-related morbidities in elderly persons with hemophilia

“…More and more elderly patients with inhibitors will also need joint replacement, which is now possible and safe but at exorbitant costs using bypassing agents. [25][26][27] Table 1 shows some schedules of replacement or bypassing therapy recommended for these operations in PWHs without and with inhibitors.…”

Surgical synovectomy of the knee in young haemophiliacs: Long-term results of a monocentric series of 23 patients

“…The pre-operative median Petrini score was 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)). The youngest patients had the best clinical status (q = 0.66, P \ 0.001).…”

“…Recurrent joint bleeding episodes lead to haemophilic arthropathy with synovial hypertrophy and progressive joint destruction. Synovectomy is indicated within the frame of management of haemophilic arthropathy, to delay total knee arthroplasty, which the rate of early and late complications has to be considered [2][3][4][5][6][7][8][9]. Long-term results of synovectomy have never been reported.…”