Hemophilic arthropathy in a patient with multi-joint replacement

Abstract

Rationale:Hemophilic arthropathy (HA) is a crucial morbidity and a major cause of joint pain and disability in patients with hemophilia A. Surgical methods, such as total joint arthroplasty, are of vital importance for end-stage HA treatment, but the feasibility and effects of multi-joint replacement surgery remain debatable.Patient concerns:A 24-year-old patient with advanced HA presented multiple joint pain. Physical examination revealed joint tenderness, swelling, and limited activity. Radiographs revealed bilateral knee joints and left elbow joint damage with joint space narrowing, articular facet erosion, and bone deformation.Diagnoses:The patient was diagnosed with hemophilic arthropathy with multi-joint lesions.Interventions:The key points of this case include arthropathy in multiple joints and the management of simultaneous total multi-joint arthroplasty. We performed bilateral total knee arthroplasty and total left elbow arthroplasty simultaneously after adequate preparations. Special attention was paid to factor VIII infusion, hemorrhage control, and other safety precautions perioperatively.Outcomes:After the surgery, no complications, such as infection or aseptic loosening, occurred, and the joints functioned well at follow-up.Lessons:The surgical outcome and safety of multi-joint replacement for HA are attested. Simultaneous multi-joint arthroplasty can ameliorate the quality of life for patients with hemophilia A.

The Urokinase Plasminogen Activation System in Rheumatoid Arthritis: Pathophysiological Roles and Prospective Therapeutic Targets

“…These findings were in line with clinical observations of increased proximal joint arthropathies ( e.g. knees, hips) in haemophilic patients [106-109]. Similarly, activation of MMP-9, a prominent pro-arthritic collagenase and plasmin substrate, was significantly inhibited in the knee joints of Plg-/- mice, whereas MMP-9 was not detected in the paws of the same animals.…”

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

“…This could be explained by the etiology of knee arthroplasty in this age group, which is typically inflammatory, tumorous, or associated with congenital pathologies, making patients more susceptible to complications. 37 38 39 40 Nevertheless, since the present study obtained its information from administrative data, the etiology of the TKAs could not be determined with certainty. In addition to age, the patient's insurer was also found to be an independent predictive factor of ICU admission rates.…”

A Retrospective, Long‐term Follow‐up of the Clinical Outcomes and Cost‐effectiveness of Single‐anesthetic Multiple Total Joint Procedures in Hemophilic Arthropathy

“…Accordingly, affected patients need perioperative high‐dose factors replacement therapy (FRT) to avoid catastrophic bleeding. Moreover, a postoperative long‐term rehabilitation program is usually indicated for these patients to enhance efficacy and decrease the risk of complications 11 . Therefore, conducting the procedure secondary to HA can be remarkably different from conducting it secondary to other etiologies.…”