Comparison of 90-Day Complication Rates and Cost Between Single and Multiple Joint Procedures for End-Stage Arthropathy in Patients with Hemophilia

Abstract

Background: Multiple joint procedures during a single anesthetic episode have been proposed for patients with hemophilia as a way to reduce cost. The postoperative 90-day complication rate and the cost distribution between multiple joint procedures and single joint procedures for patients with hemophilia have not been well studied. Methods: Between January 1996 and December 2016, 124 patients underwent 177 surgical procedures (total knee arthroplasty, total hip arthroplasty, and ankle arthrodesis) for the treatment of hemophilic end-stage arthropathy. Forty-eight patients (39%) underwent multiple joint procedures during 1 hospitalization, and 76 patients (61%) underwent single joint procedures. The medical records were retrospectively reviewed. The patients were evaluated for complications within 90 days postoperatively and the cost during hospitalization. Risk factors related to complications were further analyzed. Results: Twenty-seven of the 124 patients experienced 29 complications within 90 days postoperatively, representing a complication rate of 16.4% for all procedures. The patients who had undergone multiple joint procedures had a higher rate of surgical complications than those who had undergone a single joint procedure (14.6% vs. 3.9%; p = 0.039). The patients who had had multiple joint procedures had similar rates of hematological complications (8.3% vs. 9.2%; p = 0.867) and total complications (31.3% vs. 18.4%; p = 0.100) compared with those who had had a single joint procedure. There was no difference between the patients who had had multiple joint procedures and those who had had a single joint procedure with regard to the cost of the coagulation factor (p = 0.212). Conclusions: The performance of multiple joint procedures during a single anesthetic episode is a safe approach for patients with hemophilia with end-stage arthropathy, with no substantial increase in the 90-day complication rate in comparison with that following a single joint procedure. The performance of multiple joint procedures under a single anesthetic episode can save cost and is more cost-effective when managing patients with hemophilia who have end-stage arthropathy. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Complications of total knee arthroplasty in patients with haemophilia compared with osteoarthritis and rheumatoid arthritis: A 20‐year single‐surgeon cohort

“…On the other hand, the difficulty in perioperative replacement therapy for severe patients may also lead to the higher risk of complications 10 . Staged or simultaneous bilateral TKAs always attract debates 9,19,20 . However, there were no significant differences in complication rates between unilateral or simultaneous bilateral TKA in HA patients.…”

“…However, there were no significant differences in complication rates between unilateral or simultaneous bilateral TKA in HA patients. What is more, haemophilia patients could benefit more from simultaneous bilateral TKA because of lower cost of replacement therapy and less risk of inhibitor formation 9 …”

“…However, although some studies reported comparable outcomes of TKA in HA patients, limited data were available on the complications 8,9 . In order to have a more comprehensive understanding of the TKA safety in HA patients, it is necessary to identify the differences of complications between HA and other common articular diseases, such as osteoarthritis (OA) and rheumatoid arthritis (RA), which are the two dominated indicators of TKA.…”

Early wound complications after orthopaedic surgery for haemophilia: What can we do more

“…Up to date, there are limited studies about the early wound complication following orthopaedic surgery in PWH. The reported wound complication after orthopaedic surgery for PWH was 2.2%‐4.5% in literature, 9,20‐22 which was significantly higher than the wound complication of 0.33% after primary TKAs, according to a large population report 10 . In the present study, the incidence of early wound complication was 7.4% for all the patients and 6.5% for the patients without preoperative infection.…”

“…In summary, the operations included in this study were arthroscopy, total joint arthroplasty (TJA), resection of haemophilic pseudotumour, fracture stabilization, achilles tendon lengthening with/without ankle arthrodesis, surgery for knee flexion deformity or stiff knee. Multiple joints procedures (MJP) during one anaesthetic episode are considered when the patients suffer from multiple joints involvement to reduce the event of intensive treatment with factor concentration 9 . Cases with the early postoperative wound complications but absence of deep infection within postoperative 30 days were identified 10 .…”