Researchers discovered that despite the use of factor replacement therapy, patients with hemophilia still experienced substantial bleeding risk after total hip arthroplasty (THA) or total knee arthroplasty (TKA), as published in the Journal of Thrombosis and Haemostasis.

Patients with hemophilia often experience repeated intra-articular bleeding, which results in the inflammation of the joints and subsequent damage. Hence, hemophilic arthropathy can cause significant pain and disrupt the quality of life of patients with hemophilia.

Factor replacement therapy is a standard treatment for hemophilia, but it does not stop arthropathy from developing. Patients with hemophilia who experience significant chronic arthropathy are candidates for joint replacement surgeries.

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The risk of perioperative blood loss is high in these surgeries, even among the general population. Studies have shown that patients with hemophilia experience longer hospital stay as a result of perioperative bleeding.

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Kleiboer and colleagues conducted a prospective, observational cohort study to study the outcome of patients with hemophilia who undergo THA or TKA. The participants either had hemophilia A or B and were willing to submit themselves for a follow-up 4 to 6 weeks postsurgery.

The researchers managed to study 130 surgeries; 33 THA and 98 TKA. The results demonstrated that 46% of THA and 25% of TKA were complicated by major bleeding. “The risk of major bleeding was increased in THA compared to TKA, and by the presence of an inhibitor, and non-use of an antifibrinolytic medication,” the researchers wrote.

This study illustrates the significant bleeding risk that patients with hemophilia still experience when undergoing major surgeries. The results of the study also suggest that the risk of bleeding may be mitigated with the use of an antifibrinolytic medication.

“These considerations and the data from this study can help inform the shared decision-making process when persons with hemophilia and their providers discuss the potential risks and benefits of joint replacement surgery,” the authors concluded.


Kleiboer B, Layer MA, Cafuir LA, et al. Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: a prospective multicenter observational study. J Thromb Haemost. Published online January 26, 2022. doi:10.1111/jth.15654