Haemophilic knee arthropathy: long-term outcome after total knee replacement

Abstract

Purpose The objective of this study was to evaluate the long-term outcome and prosthetic survival of primary total knee arthroplasty in haemophilic patients. It was hypothesized that the infection and revision rate are higher and the outcome inferior when compared with patients without haemophilia. Methods Between 1985 and 2004, forty-three consecutive primary total knee replacements were performed in thirty haemophilic patients. These patients' charts were reviewed retrospectively. Twenty-five patients (34 knees) were available for clinical and radiological follow-up. The outcome was assessed using the Knee Society score, WOMAC and Kaplan-Meier survivorship analysis. Results An haematogenous infection occurred in two patients. In three patients, component revision was needed: two because of an infection and one because of a mechanical failure. After a mean follow-up of 9.6 years (2-20), 94% of the patients rated their result as either excellent or good. At time of follow-up, the Knee Society Score averaged 73.3 points (range, 29-100) and showed a significant gain (p \ 0.001) compared to preoperative. Flexion contracture could be reduced significantly (p \ 0.001) from 18.1°preoperatively to 8.4°at follow-up, whereas flexion remained unchanged. When infection or any component replacement was set as endpoints, the 10 years prosthetic survival was 90 and 86%, respectively. Conclusion Total knee arthroplasty in haemophilic patients is a reliable treatment that results in pain relief and functional improvement with a low risk of postoperative infection. However, neither the postoperative infection rate nor the functional result does reach the same level as in a population not affected by haemophilia. Level of evidence IV.

Meta‐analysis: outcomes of total knee arthroplasty in the haemophilia population

“…When looking at functional improvement postoperatively, many authors have suggested reasons more unique to the haemophilia population. Perception of better functional improvements can be attributed to the length of time the patient reports symptoms of arthropathy development before surgery, severity of symptoms, choice of implant, surgical technique, prolonged continuous infusions of factor replacement and early physical therapy .…”

“…Articles that appeared to meet screening criteria were then cross‐examined using exclusion criteria: non‐English articles, use of cryoprecipitate or frozen blood plasma due to increased risk of co‐morbidities occurring post‐surgery and association with outdated surgical techniques, and studies reporting the outcomes of fewer than five knees. Studies reporting function based on the Western Ontario and McMaster University Arthritis Index (WOMAC) were excluded, based on the limited number of studies ( n = 2) using this instrument .…”

Evaluation of outcomes of suction drainage in patients with haemophilic arthropathy undergoing total knee arthroplasty

“…Several studies stated inferior outcomes regarding achievement of ROM in haemophilia patients. Even though TKA has been effective to get rid of flexion contractures, in some reports, total range of motion has not been reported to increase postoperatively . Contrariwise some reports like the ones performed by Viliani et al .…”

Experimental study on the role of intra‐articular injection of MSCs on cartilage regeneration in haemophilia

“…Most of the outcome measures including WOMAC questionnaire are subjective [44][45][46]. Most of the outcome measures including WOMAC questionnaire are subjective [44][45][46].…”