Total hip replacement in patients with hemophilia: 13 hips in 11 patients followed for 1-16 years

Abstract

During 1973-88, we performed 13 total hip replacements in 11 hemophilia patients, mean age 46 (25-65) years. During the operation, blood loss averaged 920 mL, and a mean of 120,000 units of factor VIII/IX were used. The mean duration of follow-up was 7 (1-16) years. 5 hips became loose within 6 years, and a further one after 13 years. 4 hips were revised, 2 of them due to infection in patients who were also seropositive for HIV. At the latest follow-up, 10 patients were alive. 6 had no hip pain and 7 could walk at least 1,000 meters at a time. Although these results are inferior to those obtained in arthrosis, total hip replacement should be considered in hemophiliac patients.

Modern management of haemophilic arthropathy

“…Haemophilic arthropathy develops at a younger age than osteoarthritis, as reflected by the average age of patients with haemophilia who have undergone TKR, which ranges from 21 to 40 years, although patients as young as 15 years have been reported (Thomason et al, 1999;Norian et al, 2002; Although the knee is by far the most frequently replaced joint in haemophilia, arthroplasty is also used for other joints with severe arthropathy. Hip replacement in patients with haemophilia may offer significant pain relief and improved function, albeit with a higher rate of complications that lead to revisions in 20-57% of patients, although recent reports are more encouraging (Luck & Kasper, 1989;Nelson et al, 1992;Kelley et al, 1995;Lofqvist et al, 1996;Habermann et al, 2006). Other joints have been successfully replaced in patients with haemophilia, including the ankle, shoulder and elbow, although these are confined to case reports and small series (reviewed in Beeton et al, 2000;Dalzell, 2004).…”

Contemporary Approaches to Hemophilia

“…There is also a potential risk of virus transmission with the use of murine monoclonal antibodies during the immunoaffinity process. This risk is eliminated in Xyntha as the manufacturing process for Xyntha has replaced the murine monoclonal antibodies in the immunoaffinity step with a chemically synthesized peptide ligand with similar affinity but no risk of virus transmission [1,5,26,27].…”

“…Building on the prior generations of products, both a BDD-rFVIII (Xyntha®/Refacto® AF; Wyeth, now Pfizer) and a CHO cell line-derived full-length rFVIII (Advate) product were created, whereby all human-and animal-derived raw products were removed from the production and reconstitution processes [1,5,26,27].…”

“…Inhibitor development in hemophilia has a multifactorial etiology where both patient-specific and treatment-related factors play a role. Among severe hemophilia, major deletions, inversions, nonsense mutations and some missense mutations have shown different degrees of association with inhibitor development [26]. In mild-to-moderate HA, missense…”

Comparison of metal on metal versus polyethylene–ceramic bearing in uncemented total hip arthroplasty in patients with haemophilic arthropathy

“…Advanced haemophilic arthropathy can seriously reduce function, quality of life because of pain, impairment and loss of mobility [6,7]. Previous reports described varying results of cemented, uncemented and hybrid total hip arthroplasty (THA) in haemophilic patients, with revision rates ranging from 11.7 % to 36.4 % at a mean follow-up of five to ten years (Table 1) These failure rates are inferior compared with nonhaemophilic patients [5,2,1,6,4,8].…”