Perioperative management of hemophilia patients receiving total hip and knee arthroplasty: a complication report of two cases

Abstract

It has been recognized that perioperative hemostasis management after joint-replacement surgery for hemophilia patients is complicated and cumbersome, due to the necessity of rigorous monitoring for clotting-factor levels throughout the infusion. Between 2005 and 2014, we examined seven patients with hemophilia A (ten joints: six hips and four knees) receiving total hip or knee arthroplasty (THA or TKA) for hemophilic arthropathy. One male patient (31 years old) showed an intra-articular hematoma formation after THA (case 1). In another male patient (46 years old) receiving TKA, the postoperative trough factor VIII level became lower significantly than reference levels (80%–100% for the 5–10 postoperative days) recommended by the guidelines from the Japanese Society on Thrombosis and Hemostasis, despite sufficient coagulant based on the guidelines being administered (case 2). In the latter patient, deep infection and hematoma formation were observed postoperatively. In this article, we provide a detailed clinical report regarding these two complication cases at the early postoperative periods, and the management of bleeding control for hemophilia patients is discussed.

Hip arthroplasty in haemophilia: a systematic review

“…Another suitable study was found, giving us a final yield of 20 articles. 8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Figure 1 outlines the literature search process.…”

“…Haemostatic control is maintained by monitoring clotting-factor levels through continuous factor infusion. 8 This systematic review aims to examine the current literature regarding THA in haemophilic patients with the objective of determining clinical outcomes and complication rates.…”

“…Haemostatic control is maintained by monitoring clotting-factor levels through continuous factor infusion. 8…”

Manajemen Perioperatif Trepanasi Dekompresi Subdural Hemorrhage (SDH) dengan Hemofilia A

“…Efek puncak faktor VIII harus diperhatikan untuk memastikan kesesuaian jumlah faktor VIII yang akan diinfuskan dan interval pemberian dosis. [6][7][8] Induksi anestesi harus dilakukan dengan perlahan dan obat-obatan seperti suksinilkolin dihindari untuk mencegah guncangan atau kontraksi pada otot, yang dapat memperburuk keadaan hemoragik pada otot dan persendian. [9][10] Penggunaan infus perifer umumnya cenderung tidak mengalami pendarahan berlebihan.…”

Perioperative haematological outcomes following total knee arthroplasty in haemophiliacs

“…4 TKA in haemophiliacs is a technically challenging procedure due to the presence of anatomical deformities, arthrofibrosis and poor bone quality. 5 The perioperative course is further complicated by the need for monitored therapy of the underlying coagulation disorder, 6 while still allowing early postoperative rehabilitation. 7 Despite this, TKA has been shown to achieve excellent outcomes in this patient group, with significant improvement in pain scores, flexion contractures, range of movement and functional scores.…”