Orthopedic disorders of the knee in hemophilia: A current concept review

Abstract

The knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy (HA) in patients with deficiency of coagulation factor Ⅷ or Ⅸ and thus this manuscript seeks to present a current perspective of the role of the orthopedic surgeon in the management of these problems. Lifelong factor replacement therapy (FRT) is optimal to prevent HA, however adherence to this regerous treatment is challenging leading to breakthrough bleeding. In patients with chronic hemophilic synovitis, the prelude to HA, radiosynovectomy (RS) is the optimal to ameliorate bleeding. Surgery in people with hemophilia (PWH) is associated with a high risk of bleeding and infection, and must be performed with FRT. A coordinated effort including orthopedic surgeons, hematologists, physical medicine and rehabilitation physicians, physiotherapists and other team members is key to optimal outcomes. Ideally, orthopedic procedures should be performed in specialized hospitals with experienced teams. Until we are able to prevent orthopedic problems of the knee in PWH will have to continue performing orthopedic procedures (arthrocentesis, RS, arthroscopic synovectomy, hamstring release, arthroscopic debridement, alignment osteotomy, and total knee arthroplasty). By using the aforementioned procedures, the quality of life of PWH will be improved.

Current perspectives on biological approaches for osteoarthritis

“…Erythrocytes and leukocytes provide beneficial systemic effects to numerous biological processes, but the inclusion of erythrocytes and leukocytes in BMC therapy for cartilage and bone tissue healing and regeneration is controversial. It is known that blood‐induced joint damage enables erythrocyte and leukocyte infiltration that subsequently causes chondral and subchondral degeneration and often leads to arthritis . Historically, BM MSCs have been of particular interest for isolating owing to their multilineage differentiation capacity capable of generating chondrocytes, osteoblasts, tenocytes, myocytes, adipocytes, and mesodermal cells and to their responsiveness to surrounding environmental cells, biological factors, and mechanical stresses.…”

“…It is known that blood-induced joint damage enables erythrocyte and leukocyte infiltration that subsequently causes chondral and subchondral degeneration and often leads to arthritis. [143][144][145] Historically, BM MSCs have been of particular interest for isolating owing to their multilineage differentiation capacity capable of generating chondrocytes, osteoblasts, tenocytes, myocytes, adipocytes, and mesodermal cells 146 and to their responsiveness to surrounding environmental cells, biological factors, and mechanical stresses. For example, BM MSCs prevent neutrophil apoptosis under oxidative stress, 147 and they also express unique cytokine and chemokine receptors that cue cells to undergo proliferation or apoptosis.…”

Total knee arthroplasty in hemophilia A

“…As a result, patients with hemophilia may develop orthopaedic manifestations such as hemarthrosis. Repeated bleeding into the joints, most commonly the ankle, elbow, and knee, leads to cartilage damage and degenerative articular changes, potentially leading to severe osteoarthritis [4]. Hemophilic arthropathy has been found to be present in approximately 90% of hemophilia patients by the third decade of life [4].…”

Clinical and radiologic results after open‐wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity

“…The knee is the frequently involved joint, and deformity of the joint is frequently observed as well, probably related to mechanical overloading due to muscular malfunction and secondary loss of the ideal biomechanical axis . This condition mainly occurs in young haemophilic patients by 20‐30 years of age, in whom clotting factor supplementation has not been administered from childhood …”

“…Haemophilic arthropathy can be treated with orthopaedic procedures ranging from conservative treatment, including chemical or radial synovectomy, to surgical treatment represented by total knee arthroplasty (TKA). 4 TKA is recognized as an effective surgical option for haemophilic arthropathy. Patients with HA experience significant improvement in quality of life following TKA.…”