Comprehensive care of the patient with haemophilia and inhibitors undergoing surgery: practical aspects

Kulkarni, Roshni

doi:10.1111/j.1365-2516.2012.02922.x

Cited by 23 publications

(35 citation statements)

References 57 publications

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“…This has been well documented in the hemophiliac population undergoing TKA, with an overall infection rate of 7.9% [13]. Impaired hemostasis may impact the development of infection directly and indirectly [23]. A variety of postsurgical complications have been documented for patients with bleeding disorders including poor wound healing, increased transfusion requirements, and higher pain scores [23].…”

Section: Discussionmentioning

confidence: 99%

Total knee arthroplasty in a patient with hypofibrinogenemia

et al. 2016

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Patients with afibrinogenemia or hypofibrinogenemia present a unique challenge to the arthroplasty surgeon as fibrinogen is a key contributor to hemostasis. Patients with these disorders are known to have a higher risk for postsurgical bleeding complications. We present the case of a patient with hypofibrinogenemia who underwent an elective total knee arthroplasty. Our colleagues in hematology-oncology guided us initially to achieve and maintain appropriate fibrinogen levels in the early perioperative period. However, the patient developed an acute joint effusion and subsequent infection 4 weeks after her initial operation. Her fibrinogen levels were noted to have fallen below the target range by that time, and it was also revealed that the patient failed to follow-up with hematology-oncology to monitor her levels. Based on our review of the available literature, we recommend that patient's fibrinogen levels be closely monitored and maintained ideally >100 mg/dL not only in the initial perioperative window but perhaps for the first 4-6 weeks postoperatively as well.

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Section: Discussionmentioning

confidence: 99%

Total knee arthroplasty in a patient with hypofibrinogenemia

et al. 2016

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“…Factor VIII injection required calculation 9 All haemophilia patients underwent factor VIII replacement during the procedure. Routine prophylaxis of factor VIII was given according to patient weight (kg) and percentage of desired levels of pre and post radiosynoviorthesis is calculated by the following formula:…”

Section: Methodsmentioning

confidence: 99%

Short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 radiosynoviorthesis

Menon

et al. 2017

J Orthop Surg (Hong Kong)

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Purpose: Various modes of therapy have been directed at breaking the vicious cycle at early stage of synovitis in haemophilia patients. This study was planned to assess the short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 (P-32) radiosynoviorthesis. Methods: P-32 samarium radiocolloid was injected into the knee and patients were followed up at 1 and 3 months, respectively. Clinical outcomes was assessed using Tegner Lysholm scores (TLSs), Modified Knee Society Clinical Rating System (MKSS) score and circumference of the knee joint. The radiological outcomes were assessed using X-ray, ultrasonography and bone scan. Results: Among the fifteen haemophilia A patients studied, there was statistically significant difference in TLS (w 2 (2) ¼ 27.887 and p value < 0.001), MKSS scores (w 2 (2) ¼ 27.745 and p < 0.001) and circumference of the knee joint (w 2 (2) ¼ 21.333 and p < 0.001) at preoperatively, 1-and 3-month follow-up. There were no changes noted in follow-up X-rays compared with the preoperative X-ray. Ultrasonography showed that clinical improvement was more in suprapatellar and medial parapatellar regions in the last 2 months compared to the first month of follow-up. Post P-32 bone scan showed marked decrease in uptake in the affected knee joint suggestive of radio ablation of synovial tissue. Conclusion: P-32 radiosynoviorthesis done for chronic synovitis among haemophilia A patients showed significant improvement in both clinical and radiological parameters. Ultrasonography can be utilized as non-invasive radiological modality for follow-up of P32 response for knee joint.

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“…Factor VIII injection required calculation [9] : All haemophilia patients underwent factor VIII replacement during the procedure. Routine Prophylaxis of factor VIII was given according to patient weight (kg) and percentage of desired levels pre and post radiosynovectomy is calculated by the following formula.…”

Section: Methodsmentioning

confidence: 99%

Clinical outcome of radiosynovectomy in haemophilia a patients with chronic knee synovitis

Ty¹,

Menon²,

Ar³

2017

Int. J. Orthop. Sci.

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Aim: There are various medical and surgical modalities available at breaking the vicious cycle of synovitis-hemarthrosis-synovitis at an early stage of synovitis in patients of haemophilia. Our study was planned to assess the short term clinical outcome in chronic knee synovitis among haemophilia A patients treated with phosphorus-32 (P-32) radiosynovectomy. Methods: Fifteen haemophilia A patients with chronic knee synovitis were injected with P-32 Samarium radiocolloid into the knees. These patients were clinically assessed at time of injection, at one and at three months post procedure. The parameters evaluated are the Tegner Lysholm Score (TLS), Modified Knee Society Clinical Rating System score (MKSS) and by measuring the circumference of the knee joint pre and post injection. Results: Among the fifteen haemophilia A patients studied, there was statistically significant difference in all three parameters recorded with TLS having χ2 (2) = 27.887 and p value <0.001, MKSS scores having χ2 (2) = 27.745 and p <0.001, and circumference of the knee joint showing χ2 (2) = 21.333 and p <0.001 at the end of one and three months follow up. Conclusion: P-32 radiosynovectomy done for chronic knee synovitis among haemophilia A patients showed significant improvement in clinical parameters. Hence we suggest that this simple procedure may be added to the armamentarium of current options available for these patients.

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Comprehensive care of the patient with haemophilia and inhibitors undergoing surgery: practical aspects

Cited by 23 publications

References 57 publications

Total knee arthroplasty in a patient with hypofibrinogenemia

Total knee arthroplasty in a patient with hypofibrinogenemia

Short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 radiosynoviorthesis

Clinical outcome of radiosynovectomy in haemophilia a patients with chronic knee synovitis

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