One‐stage replacement of infected knee prosthesis in a patient with haemophilia A and high titre of inhibitors

Sartori, Roberto; Bisson, R.; Baars, G. W.; Petris, U.; Radossi, Paolo; Risato, Renzo; Tassinari, Cristina; Tagariello, Giuseppe

doi:10.1111/j.1365-2516.2007.01619.x

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…Such procedures, even if usually technically demanding and sometimes very close to limb salvage surgery, have more than acceptable outcomes. 6,27,39 Modern orthopaedic surgery's procedures have been associated to good clinical outcomes: this is undoubtedly related to the introduction of rFVIIa and aPCC that have significantly improved the management of patients with inhibitors, by an efficient control of coagulation during and after major surgery. 13,14,19,20,22,24,30,40,41 Particularly, around 400 procedures have been reported as successful using rFVIIa, 24 and recently more than 200 using aPCC with a reported efficacy rates of about 87% to 100% and 57% to 79% respectively.…”

Section: Discussionmentioning

confidence: 99%

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Joint replacement for the management of haemophilic arthropathy in patients with inhibitors: A long‐term experience at a single Haemophilia centre

et al. 2020

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Introduction The association between haemophilia and the so‐called ‘inhibitors’, alloantibodies against the infused factor able to neutralize its clotting activity, is a very rare condition. Those sporadic patients suffer of an even more severe arthropathy and performing primary or revision arthroplasty become truly challenging. Literature about this topic is scarce, consisting in small case series, high rates of complications and mid‐term follow‐ups. Aim The purpose of this study is the assessment of the long‐term outcomes of primary and revision arthroplasty performed in a population of patients with inhibitors, the more consistent to date reported at a single haemophilia centre. Methods We reviewed the records of 18 patients with inhibitors (26 procedures) between 1999 and 2017, divided in two groups. Group A [primary total Knee‐Hip arthroplasty (TKA‐THA)]: 13 patients underwent 19TKA and 2THA; and B (revision): 5 subjects underwent 3rTKA and 2rTHA. All patients received the same haematological prophylaxis (rFVIIa). Haemophilic Joint Health score and VAS, and X‐rays were recorded pre‐ and postoperatively. The survival rate of all primary implants was assessed. Results The median follow‐up was 12.2 years (3‐21) for group A, 8.6 years (4‐12) for B. Few complications have been reported; the overall survival rate was 94.7% at 15 years. All patients reported satisfaction, pain reduction and improved functional ability. Conclusion Primary and revision TKA/THA in haemophilic subjects and inhibitors may be nowadays considered safe and effective if performed in dedicated multidisciplinary centres. The use of continuous infusion of rFVIIa showed an adequate haemostatic effect and low rate of complications. As expected, revisions are more prone to complications compared to primary arthroplasty.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, complications of TKA and THA may be managed by revision or joint fusion, definitely better alternatives than amputation. Such procedures, even if usually technically demanding and sometimes very close to limb salvage surgery, have more than acceptable outcomes 6,27,39 …”

Section: Discussionmentioning

confidence: 99%

Joint replacement for the management of haemophilic arthropathy in patients with inhibitors: A long‐term experience at a single Haemophilia centre

et al. 2020

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“…By cross‐checking relevant articles, additional articles were added to the list in a non‐standardized manner. Almost 60 articles were identified describing 332 EOS procedures [7,9–36,41,43–58,60–69,73–75]. Based on the classification of Perez Bianco et al.…”

Section: Discussionmentioning

confidence: 99%

“…However, the majority of data on the use of rFVIIa are derived from case studies. A number of case studies have reported on the successful use of rFVIIa as haemostatic cover during elective surgery in haemophilia patients with high‐titer inhibitors [7,8,10–58]. In addition, results from a recent cost–benefit analysis suggest that major knee surgery using rFVIIa in haemophilia patients with inhibitors may be cost‐effective because of the reduced number of bleedings or improved quality of life experienced by these individuals following surgery [59].…”

Section: Introductionmentioning

confidence: 99%

Elective orthopaedic surgery for haemophilia patients with inhibitors: single centre experience of 40 procedures and review of the literature

et al. 2011

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With the introduction of safe and effective factor VIII/IX-bypassing agents--recombinant activated factor VII (rFVIIa) and plasma-derived activated prothrombin complex concentrates (pd-APCC)--elective orthopaedic surgery (EOS) is a viable option for haemophilia patients with inhibitors. We report a series of patients with haemophilia and inhibitors undergoing EOS between 1997 and 2008 using bypassing agents to provide haemostatic cover. All inhibitor patients undergoing EOS and receiving rFVIIa, plasma-derived prothrombin complex concentrates (pd-PCC) or pd-APCC as haemostatic cover were included. Patients were operated on by the same surgeon and were managed by the same haemophilia treatment centre. Forty procedures (25 minor and 15 major) were conducted in 18 patients. Twenty-one minor cases were covered using rFVIIa, three with pd-PCC, and one with pd-APCC; all major cases were covered using rFVIIa. Bleeding was no greater than expected compared with a non-haemophilic population in all 25 minor procedures. In the major procedure group, there was no excessive bleeding in 40% of cases (6/15) and bleeding completely stopped in response to rFVIIa. For the remaining nine cases, bleeding response to rFVIIa was described as 'markedly decreased' or 'decreased' in 4/15 cases and 'unchanged' in 5/15 cases. Overall, efficacy of rFVIIa, based on final patient outcome, was 85%. One death occurred as a result of sepsis secondary to necrotizing fasciitis. Good control of haemostasis can be achieved with bypassing agents in haemophilia patients with inhibitors undergoing minor EOS; rFVIIa was used as an effective bypassing agent, enabling EOS in patients undergoing minor and major procedures.

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Continuous infusion of recombinant activated factor VII: a review of data in congenital hemophilia with inhibitors and congenital factor VII deficiency

Rajpurkar

Cooper

2018

JBM

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IntroductionContinuous infusion (CI) of clotting factors as a replacement therapy for perioperative hemostatic protection has been performed for many years, including with factors VIII and IX and recombinant activated factor VII (rFVIIa). This approach provides steady factor levels without requiring frequent administration of bolus doses.AimTo review safety, efficacy, and dosing data regarding CI of rFVIIa for hemostatic management of patients with congenital hemophilia with inhibitors (CHwI) or congenital factor VII deficiency (C7D).Materials and methodsA literature review identified instances of CI of rFVIIa in patients with CHwI or C7D undergoing surgery or experiencing bleeding episodes. Data regarding safety, efficacy, and dosing were extracted.ResultsThe safety and efficacy of 50 mcg/kg/h CI of rFVIIa following a 90 mcg/kg bolus injection, vs a standard bolus injection regimen, was reported for 24 patients with CHwI undergoing elective surgery in an open-label, randomized, Phase III trial. Efficacy was similar between CI and bolus injection groups at all postoperative time points assessed. Additionally, a postmarketing surveillance study reported effective (80%) and partially effective (20%) CI of rFVIIa in a Japanese cohort of ten patients with CHwI who underwent 15 surgical procedures. Finally, the safety and dosing of rFVIIa CI in 193 and 26 patients with CHwI and C7D, respectively, were reported in 11 prospective studies, 10 retrospective studies, and 30 case reports. No unexpected safety findings were reported.ConclusionrFVIIa CI has been performed safely and effectively in patients with CHwI and C7D undergoing surgery and during bleeding episodes in patients with CHwI.

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One‐stage replacement of infected knee prosthesis in a patient with haemophilia A and high titre of inhibitors

Cited by 3 publications

References 6 publications

Joint replacement for the management of haemophilic arthropathy in patients with inhibitors: A long‐term experience at a single Haemophilia centre

Joint replacement for the management of haemophilic arthropathy in patients with inhibitors: A long‐term experience at a single Haemophilia centre

Elective orthopaedic surgery for haemophilia patients with inhibitors: single centre experience of 40 procedures and review of the literature

Continuous infusion of recombinant activated factor VII: a review of data in congenital hemophilia with inhibitors and congenital factor VII deficiency

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