Orthopaedic Status and Surgical Needs of Patients with Haemophilia in Algeria

Abstract

Despite the availability of factor replacement to manage acute bleeding in haemophilia, haemarthrosis may occur due to delayed therapy or lack of detection, leading to joint damage. Orthopaedic surgery is one option to help improve patient quality of life. Assessment of current treatment patterns is required for physicians to optimize long-term management of patients; however, there are few studies available to determine the real-life situation in African/Middle-Eastern countries, such as Algeria. This was a multicentre, retrospective study of patients with haemophilia treated with on-demand factor replacement. Seven haematology centres in Algeria provided evaluable clinical data for 536 patients, including joint status and requirement for surgical intervention. Surgery was recommended in 326 (61%) patients (239 patients with severe haemophilia, 79 moderate and eight mild). Surgical procedures per patient age group were: 11 in patients ≤5 years, 34 in 6-10 years, 169 in 11-20 years, 183 in 21-30 years and 122 in ≥31 years. 14% of all procedures involved joint replacement, 56% other major surgeries and 30% minor surgeries (synoviorthesis). Minor surgery was most common in younger patients, while major surgeries increased proportionately with patient age. In Algeria, insufficient use of factor replacement has led to many patients with haemophilia experiencing haemarthrosis, leading to joint damage requiring surgery. This study aids assessment of the scale of the problem and identification of the surgical needs of patients. This may help plan targeted resourcing for patients most at risk of long-term disability and those likely to benefit from earlier surgical intervention.

Major and Minor Classifications for Surgery in People With Hemophilia: A Literature Review

“…Across all 35 publications, there was a wide range of surgical procedures categorized as being major or minor (Tables 1 and 2). 9,16 –42 Two articles defined surgical specialties (eg, orthopedic, cardiothoracic, neurosurgical), rather than individual procedures, as being major or minor. 18,40 In general, major surgical procedures were more likely to have been carried out under general anesthetic, while minor surgical procedures tended to be carried out under local anesthetic (Table 2).…”

“…Interestingly, despite the difficulties in classification, 1 consensus article on surgery in people with hemophilia with inhibitors considered it essential to include an intermediate type of surgery, 6 although only 2 of 35 analyzed articles included an intermediate category. 17,33 We do not consider that criteria for intermediate surgery are necessary as it would be unlikely to change aspects of management for patients about to undergo surgery and would most probably create confusion among clinicians. At present, despite a lack of definitions, major and minor surgeries are undertaken safely and effectively in people with hemophilia.…”

HAEMOcare: The First International Epidemiological Study Measuring Burden of Hemophilia in Developing Countries

“…2 3 4 5 6 7 Few studies have been reported from developing countries. 8 9 10 Burden-of-disease studies are needed in developing nations to prioritize determinants of hemophilia care and to formulate adapted management strategies to improve outcomes.…”

Arthroplasty in haemophilia: Double‐edged sword in low/middle‐income countries

“…14% of the overall surgeries were joint replacement surgeries with the youngest patient being 11 years of age. 4 Nepal is a low/middle-income country (LMIC) with GDP of USD…”

“…In a study conducted in Algeria, 61% of patients required surgical intervention due to joint disease and the majority of the surgical intervention was carried out before 30 years of age. 14% of the overall surgeries were joint replacement surgeries with the youngest patient being 11 years of age 4 …”