In patients with hemophilia A and end-stage arthropathy of the hip, the use of total hip arthroplasty (THA) has been an effective tool, according to a retrospective study published in Medicine.
Recognizing that 90% of patients with hemophilia will develop hemophilic arthritis in the second and third decades of life, the investigators sought to evaluate clinical outcomes and complication rates associated with bilateral THA among this population and to review the surgical strategy.
Currently, no cure for hemophilia exists, with the main treatment involving substitution therapy with the administration of exogenous factor VIII (FVIII). A treatment option for end-stage hemophilic arthropathy of the hip is THA, which provides both functional restoration and relief from pain.
The present study was based on a review of a case series from August 2012 through July 2016. During this time period, THA was performed on 48 hips in a total of 24 male patients with hemophilia A. The average patient age was 40.6±7.8 years (range, 26 to 56 years) at the time of THA. A single experienced chief orthopedic surgeon at the First Affiliated Hospital of Zhejiang Chinese Medical University in Hangzhou performed all of the procedures.
Patients’ hemophilia severities were based on their FVIII level. Overall, 18 participants had severe disease (FVIII activity <1%), and 6 individuals had moderate disease (FVIII activity 1% to 5%). During the perioperative period, a standardized protocol that followed the World Federation of Hemophilia Guidelines was used for disease management. Any patient who experienced massive bleeding during surgery was administered additional fresh frozen plasma and FVIII.
All participants underwent clinical and radiologic assessments at 6 weeks, 3 months, 6 months, and 1 year following surgery, then annually thereafter. Overall, surgery was completed successfully in all 24 participants. Patients’ total time in surgery varied from 120 minutes to 180 minutes. The average total blood loss amount was 225 mL; the mean volume of red blood cells transfused was 2.4 U. The mean volume of clotting FVIII used in the perioperative management of hemophilia was 30,600 U. Mean hospital stay was 24 days.
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It is well known that postsurgical bleeding complications in patients with hemophilia are likely the most common type of complication following such major orthopedic surgery as THA—particularly bilateral THA.
Results of the study showed that hip joint function improved significantly after surgery, with the outcome considered excellent in 17 patients, good in 5 patients, and fair in 4 patients, which corresponded to an excellence rate of 91.67%. Per imaging examinations, osseous fixation was attained in all patients. Further, no major radiologically visible complications, including osteolysis or prosthesis loosening, were observed.
“With excellent operative techniques and hematological management, bilateral simultaneous THA can provide satisfactory outcomes in hemophilia A patients with end-stage arthropathy,” the investigators concluded.
He BJ, Mao Q, Li J, Lv SJ, Tong P, Jin HT. Bilateral synchronous total hip arthroplasty for end-stage arthropathy in hemophilia A patients: a retrospective study. Medicine (Baltimore). 2022;101(27):e29667. doi:10.1097/MD.0000000000029667