Postoperative outcomes of total knee arthroplasty (TKA) favor its use for patients with hemophilia as a treatment option for hemophilic arthropathy (HA), according to a study recently published in the Journal of Orthopedics and Traumatology.

“It is the best choice for end-stage HA,” the authors wrote.

This retrospective study included 28 male patients with an average of 38.6 years of age, and a previous diagnosis of hemophilia, for a total of 32 knees with HA treated with TKA. The researchers measured the efficacy of the surgery by registering preoperative and postoperative scores on a range of motion (ROM), flexure contracture, the clinical and functional Knee Society Score (KSS), and Visual Analog Scale (VAS). Overall, all values exhibited improvement.


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When comparing preoperative evaluation with a 69.1±5.1 month follow-up assessment, median values of ROM went up 16.4 points, flexure contracture decreased 6.8 points, clinical and functional KSS scored 29.2 and 16.8 points higher, respectively, and the VAS was 1.9 points down. Importantly, 100% of the participants reported postoperative satisfaction, with 78.1% further claiming to be “very satisfied.”

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Regarding the safety of this surgical approach, the authors hypothesized that patients with hemophilia would have higher complication rates than those without this diagnosis. However, the incidence of postoperative complications was 15.6% in the study, which stands below the reported in previous research.

The most frequent complication was tension blisters of incision, present in 2 of the participants, followed by redness and swelling of the surgical incision, injury of the quadriceps femoris muscle, and suspicious prosthesis loosening, each observed in only 1 patient. None experienced infections or deep venous thrombosis.

Hemophilia predisposes to abnormal bleeding patterns, soft tissue contractures, bony deformities, and muscle atrophy. Hence, optimal hematological management, strict infection prevention, and adequate rehabilitation are some important areas to pay close attention to during this type of surgical procedure, as pinpointed by Want and colleagues.

“Under elaborative and comprehensive management, TKA is effective and safe in patients with advanced HA on the basis of mid-term follow-up outcomes,” they concluded.

Reference

Wang R, Wang Z, Gu Y, et al. Total knee arthroplasty in patients with haemophilic arthropathy is effective and safe according to the outcomes at a mid-term follow-up. J Orthop Traumatol. Published online July 11, 2022. doi:10.1186/s10195-022-00648-5