BackgroundThe results of total knee arthroplasty (TKA) in patients with inherited bleeding disorders (IBDs) are poorer when compared with those in the general population, with a notably higher risk of complications and higher revision rates. Thus, revision procedures are becoming a growing concern in this group of patients. The aim of this study was to evaluate the results of revision TKA in patients with IBD.Material/MethodsA retrospective cohort study with longitudinal assessment of hemophilia patients scheduled for revision TKA between January 2010 and September 2015 was performed. The clinical status of the patients was assessed based on the Knee Society Score, and the Numeric Rating Scale was used to assess knee pain severity and patient satisfaction with the surgery. Radiological examination, post-operative complications, and reinterventions were recorded and analyzed.ResultsVery good results were obtained in all patients treated for aseptic loosening of the implant. However, inferior results were found in cases with infection. All patients operated on for aseptic loosening required only single-stage TKA, whereas patients with infection underwent multiple interventions. Complications were observed only in cases with infection.ConclusionsOur study clearly outlined the differences in results based on failure mode, with far inferior results obtained in cases with infection. Given the lack of data in this area as well as the high specificity of this population, further high-quality studies are needed.

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Summary. Inherited factor VII (FVII) deficiency is a rare coagulation disorder with variable haemorrhagic manifestations. In severely affected cases spontaneous haemarthroses leading to advanced arthropathy have been observed. Such cases may require surgery. Therapeutic options for bleeding prevention in FVII deficient patients undergoing surgery comprise various FVII preparations but the use of recombinant activated factor VII (rFVIIa) seems to be the treatment of choice. To present the outcome of orthopaedic surgery under haemostatic coverage of rFVIIa administered according to the locally established treatment regimen in five adult patients with FVII baseline plasma levels below 10 IU dL À1. Two patients required total hip replacement (THR); three had various arthroscopic procedures. Recombinant activated factor VII was administered every 8 h on day of surgery (D0) followed by every 12-24 h for the subsequent 9-14 days, depending on the type of surgery. Factor VII plasma coagulation activity (FVII:C) was determined daily with no predefined therapeutic target levels. Doses of rFVIIa on D0 ranged from 18 to 37 lg kg À1 b.w. and on the subsequent days -from 13 to 30 lg kg À1 b.w. Total rFVIIa dose per procedure ranged from 16 to 37.5 mg, and the total number of doses per procedure was 16-31. None of our patients developed excessive bleeding including those in whom FVII:C trough levels returned nearly to the baseline level on the first post-op day. Preliminary results demonstrate that rFVIIa administered according to our treatment regimen is an effective and safe haemostatic agent for hypoproconvertinaemia patients undergoing orthopaedic surgery.

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STRESZCZENIEWstęp. Po wpro wa dze niu do po wszech ne go uży cia en do pro tez sta wu sko ko wo -go le nio we go no wej ge ne ra cji, allo pla sty ka cał ko wi ta te go sta wu sta ła się al ter na ty wą wo bec ar tro de zy w za awan so wa nych zmia nach zwy rod nie niowych. Ce lem pra cy by ło przed sta wie nie wstęp nych wy ni ków aloplasty ki cał ko wi tej bez ce men to wej sta wu sko ko wo --go le nio we go u cho rych ze zmia na mi zwy rod nie nio wy mi.Ma te riał i me to dy. W la tach 2012-2014 w Kli ni ce Or to pe dii i Trau ma to lo gii Cen tral ne go Szpi ta la Kli nicz ne go MSW w War sza wie wy ko na no 12 cał ko wi tych aloplastyk bez ce men to wych sta wu sko ko wo -go le nio we go z uży -ciem en do pro te zy Mo bi li ty. Wśród ope ro wa nych by ło 7 ko biet i 5 mę żczyzn, w wie ku 27 do 72 lat. W 9 przy padkach przy czy ną aloplasty ki by ły za awan so wa ne po ura zo we zmia ny zwy rod nie nio we, na to miast w 3 przy pad kach artro pa tia he mo fi lo wa. Oce nę kli nicz ną wy ko na no na pod sta wie ska li AOFAS i ska li bó lo wej VAS. Okres ob ser wa cji wy no sił co naj mniej 0,5 ro ku.Wy ni ki. U wszyst kich pa cjen tów stwier dzo no znacz ne go stop nia po pra wę. W ska li AOFAS po pra wa wy ni ku poope ra cyj ne go w sto sun ku do przed ope ra cyj ne go wy no si ła 43,0 (± 7,5), zaś w ska li VAS od po wied nio 5,2 (± 0.8) pkt. Ra dio lo gicz nie we wszyst kich przy pad kach stwier dzo no ana to micz ne usta wie nie en do pro te zy, brak by ło zaś cech jej ob lu zo wa nia.Wnio ski. 1. Cał ko wi ta bez ce men to wa aloplasty ka sta wu sko ko wo-go le nio we go wy da je się w chwi li obec nej optymal nym roz wią za niem w le cze niu za awan so wa nych zmian zwy rod nie nio wych te go sta wu. 2. Bez względ nie ko niecznym wa run kiem uzy ska nia do brych wy ni ków le cze nia ope ra cyj ne go jest pra wi dło wa kwa li fi ka cja do za bie gu en dopro te zo pla sty ki te go sta wu.Sło wa klu czo we: aloplasty ka sta wu sko ko wo -go le nio we go, zmia ny zwy rod nie nio we, ar tro pa tia he mo fi lo wa SUMMARY Background. Since new generation ankle endoprostheses came into common use, total ankle arthroplasty has become an alternative to arthrodesis in the treatment of advanced osteoarthritis. The aim of paper was present preliminary results of cementless total ankle arthroplasty in patients with osteoarthritis.Material and methods.In 2012-2014, 12 cementless total arthroplasties of the ankle joint with a Mobility implant were conducted at the Department of Orthopaedics and Traumatology of the Central Clinical Hospital of the Ministry of Interior in Warsaw. The patients were 7 women and 5 men aged 27-72 years. Nine of the patients had the arthroplasty procedure due to severe post-traumatic degenerative changes while 3 patients had haemophilic arthropathy. Clinical assessment was based on the AOFAS scale and the VAS pain scale. The patients were followed up for at least 6 months.Results. All patients improved considerably. After surgery, the AOFAS score improved by 43.0 (± 7.5) points against baseline...