Total joint arthroplasty in haemophilia

Abstract

In severely affected haemophilic patients arthropathy is a common problem which can lead to considerable pain and functional deficit. Surgical management, including total joint arthroplasty, can be undertaken if conservative management fails. A search of the literature showed that a number of studies describing the use of total knee arthroplasty (TKA) and total hip arthroplasty (THA) in haemophilia have been published, whereas shoulder, elbow and ankle arthroplasties are confined to case reports. This paper reviews the functional outcome of arthroplasty in the different joints, the postoperative and long-term complications, and the impact of HIV. Although complications are commonly described and the surgery is technically demanding, the results suggest that arthroplasty, particularly of the hip and knee, can be a valuable option in the management of severe haemophilic arthropathy.

Total hip replacement in patients with severe bleeding disorders

“…Kelley et al reported in a multicentre trial on 34 hip arthroplasties in 28 years [12]. Total hip arthroplasty is less common than total knee arthroplasty [2,16]. The first reported arthroplasty of the hip in a haemophiliac patient was in 1967.…”

Modern management of haemophilic arthropathy

“…Over time, advances in orthopaedic surgery and postoperative care have improved the outcome of TKR (Legroux-Gerot et al, 2003). Pain relief can be achieved in the vast majority of patients who undergo TKR, but improvements in postoperative ROM are more variable (Small et al, 1983;Beeton et al, 2000;Legroux-Gerot et al, 2003). Factors which may influence the ROM outcome include soft tissue contracture, stage of joint deterioration, type of prothesis, and postoperative mobilisation (use of a continuous passive motion machine or manipulation under anaesthesia) (Beeton et al, 2000).…”

“…Pain relief can be achieved in the vast majority of patients who undergo TKR, but improvements in postoperative ROM are more variable (Small et al, 1983;Beeton et al, 2000;Legroux-Gerot et al, 2003). Factors which may influence the ROM outcome include soft tissue contracture, stage of joint deterioration, type of prothesis, and postoperative mobilisation (use of a continuous passive motion machine or manipulation under anaesthesia) (Beeton et al, 2000). Patients whose ROM does not increase may nonetheless experience improved functional mobility as a result of improvement in flexion contracture (Beeton et al, 2000).…”

Multidiciplinary Treatment of a Haemophilic Person with Total Hip Replacement Surgery- A Case Report

“…The general surgical principles are the same but tissue handling must be careful with particular attention paid to securing haemostasis [13,20]. The total joint replacement surgery is technically demanding, and complications are commonly described, particularly of the hip and knee [11]. There are many studies that demonstrated the outcome after total knee arthroplasty, because the knees are one of the targets joints in people with haemophilia [11].…”

“…Radiosynovierthesis, arthroscopic and open synovectomy, reduction of the osteophites and removing of loose bodies, arthroplasty and arthrodesis are the main surgical options for the chronic haemophilic arthropathy [11]. Total joint replacement is used more often on knee and hip joints that may improve the quality of life of these patients [11,12]. The postoperative rehabilitation is crucial for better outcome of these patients [13].…”