Risks and patient outcomes of surgical intervention for hemophilic arthropathy

Rodríguez-Merchán, E. Carlos

doi:10.1080/17474086.2019.1602035

Cited by 11 publications

(6 citation statements)

References 66 publications

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“…In the field of osteoarthrosis, it is known that the outcome of knee replacement surgery is related to the function of the descending pain pathway. 24 Therefore, the pain-specific outcome of PwH, who have greater risks of postoperative complications in general, 32,33 should be preoperatively assessed in detail in order to balance potential surgical risks and benefits. Also, the assessment of descending pain modulation by CPM has been found to be a predictor not only for the future pain status but also for the efficacy of pharmacological as well as non-pharmacological interventions.…”

Section: Discussionmentioning

confidence: 99%

Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation

Krüger

Hilberg

2020

Haemophilia

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Introduction Haemophilic arthropathy is associated with pain that often becomes chronic, likely caused by peripheral and central mechanisms. In the field of haemophilia, to our knowledge, the role of the descending pain pathway, which can also be involved in these pain processes, has not been examined to date. Aim In light of the dearth of existing literature, we sought to evaluate the function of endogenous descending pain modulation in patients with haemophilia. Methods Thirty adult patients with moderate to severe haemophilia A or B (median [interquartile range] age 51.0 [42.0‐54.0]) and 23 healthy adult controls (age 46.5 [36.8‐54.3]) underwent conditioned pain modulation (CPM) in order to examine the function of endogenous pain modulation. The CPM response was determined by scoring a test stimulus (heat) alone as well as under the influence of a conditioning stimulus (cold) on the basis of a numeric rating scale (NRS) (0 = ‘no pain’ to 100 = ‘worst possible pain’). Results Patients with haemophilia demonstrated a statistically significant reduced CPM response when compared with the age‐matched healthy controls (median (interquartile range) NRS score: patients: −10 (−17.5‐[−7.5]) vs controls: −20 (−30.0‐[−13.75]); P = .002). The determined difference in the CPM response between both cohorts showed a medium effect size of r = .433. Conclusion The results of this study indicate that an impaired degree of endogenous pain modulation could be present in patients with haemophilia. Therefore, the function of the descending pain pathway should be considered regarding an individual and comprehensive pain management.

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Section: Discussionmentioning

confidence: 99%

Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation

Krüger

Hilberg

2020

Haemophilia

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“…The most commonly used ones in our hospital are radiosynovectomy, for cases of chronic hemophilic synovitis refractory to hematologic treatment [5,18,19]; arthroscopic ankle joint debridement, especially indicated for resecting an anterior distal osteophyte from a painful ankle [3][4][5]; and total knee arthroplasty (TKA) for cases of very painful advanced hemophilic arthropathy that has not responded to analgesia (paracetamol and oral COX-2 inhibitors), Physical and Rehabilitation Medicine. Analgesia should never be administered through the intramuscular route, the only anti-inflammatory drugs recommended in hemophilic patients being COX-2 inhibitors.…”

Section: Indications For Orthopedic Surgerymentioning

confidence: 99%

Orthopedic surgical procedures in people with hemophilia

Encinas-Ullán¹,

Corte‐Rodríguez²,

Gómez-Cardero³

et al. 2023

Blood Coagulation &Amp; Fibrinolysis

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People with hemophilia tend to develop joint lesions secondary to the recurrent hemarthroses typical of their condition. These usually include chronic synovitis and arthropathy chiefly affecting their ankles, knees, and elbows. In addition, muscular hematomas, albeit less frequently, may also result in complications such as acute compartment syndrome, pseudotumors, bone cysts and peripheral nerve compression. Joint lesions may require some of the following surgical interventions: arthroscopic synovectomy (in cases of synovitis), arthroscopic joint debridement, radial head resection, opening-wedge tibial osteotomy, arthrodesis, arthrodiastasis (of the ankle), tendon lengthening (hamstrings, Achilles tendon), progressive extension of the knee by placing an external fixator in cases of flexion contracture of the knee, supracondylar femoral extension osteotomy in cases of knee flexion contracture and, eventually, a total joint arthroplasty when the affected joint has been destroyed and the patient experiences severe joint pain. Total knee arthroplasty in hemophilic patients is associated with a high infection risk (7% on average). As regards the complications following muscle hematomas, acute compartment syndrome requires urgent performance of a fasciotomy when hematological treatment is incapable of resolving the problem. Surgical resection of hemophilic pseudotumors is the best solution, with those affecting the pelvis (secondary to iliopsoas hematomas) being particularly difficult to resolve. Peripheral nerve lesions can often be effectively addressed with hematological treatment, although a surgical neurolysis of the ulnar nerve is indicated if nonoperative treatment fails.

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“…[5][6][7] PWH who progress to end-stage HA are candidates for joint replacement surgery, which is considered an effective intervention for providing relief from intractable pain and restoring joint function. [8][9][10] Major orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA), carry a significant risk of perioperative blood loss and need for transfusion, even in the general population. [11][12][13] These risks are potentially heightened in PWH due to their underlying bleeding diathesis and despite clotting factor replacement.…”

Section: Introductionmentioning

confidence: 99%

“…The widespread adoption of prophylactic factor replacement has not conferred total protection against the development of HA; even in PWH receiving primary or secondary clotting factor prophylaxis, many still develop HA 5–7 . PWH who progress to end‐stage HA are candidates for joint replacement surgery, which is considered an effective intervention for providing relief from intractable pain and restoring joint function 8–10 …”

Section: Introductionmentioning

confidence: 99%

Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study

Kleiboer

Layer

Cafuir

et al. 2022

Journal of Thrombosis and Haemostasis

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Background: Persons with hemophilia (PWH) are at risk for chronic hemophilic arthropathy (HA). Joint replacement surgery may be used to relieve intractable pain and/or restore joint function.Objectives: This multicenter, prospective, observational cohort study evaluated the rate of bleeding during the postoperative period after total hip (THA) or knee arthroplasty (TKA).Patients/Methods: We included PWH of any severity ≥18 years of age who were undergoing THA or TKA. Clinical decisions were made at the discretion of the treating physician according to local standards of care. Clinical data were prospectively recorded. Major bleeding was defined as bleeding in a critical site, bleeding that resulted in either a 2 g/dl or greater decrease in hemoglobin during any 24-h period, or transfusion of two or more units of packed red blood cells.

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Risks and patient outcomes of surgical intervention for hemophilic arthropathy

Cited by 11 publications

References 66 publications

Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation

Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation

Orthopedic surgical procedures in people with hemophilia

Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study

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