Outcomes in total elbow arthroplasty in patients with haemophilia at the University of California, San Francisco: a retrospective review

Abstract

Severe haemophilic arthropathy of the elbow is a significant cause of morbidity among adults with haemophilia. However, previous reports of total elbow arthroplasty (TEA) in the haemophilic population have been based on small numbers of patients with relatively short-term follow-up. The records of seven total elbow arthroplasties in six adult men with haemophilia at the University of California, San Francisco who underwent TEA over a period of 25 years were retrospectively reviewed. Type of haemophilia, age at time of TEA, HIV infection status, pre- and postoperative range-of-motion (ROM) scores, complications (including infections), need for subsequent surgical revision and functional outcomes were recorded. Four patients had severe factor VIII deficiency and two patients had severe factor IX deficiency. None of the patients had an inhibitor. The mean age at the time of surgery was 34 years (range, 22-46 years) and the mean follow-up period was 118 months (range, 37-176 months). One of the six patients had TEA in both elbows. Five of the six patients were infected with HIV. There were no immediate perioperative complications. At a mean of 19.2 months postoperatively, ROM had improved in five of seven TEAs: mean flexion had increased from 110.7° (SD = 15.0) to 120.1° (SD = 14.5), whereas mean preoperative extension increased from -44.3° (SD = 21.5) to -36.9° (SD = 27.0). One patient required a revision at 30 months because of ulnar component loosening. This same patient sustained a staph epidermidis infection and ultimate removal of the prosthesis 15 years postoperatively. At a mean of 118 months postoperatively, five of six patients continued to report reduced pain and preserved functionality, with ability to perform normal daily activities. TEA resulted in favourable results in six of seven procedures. Our findings support the viability of TEA for individuals with severe haemophilic arthropathy of the elbow, especially to reduce pain and preserve or restore functionality.

Total elbow arthroplasty in haemophilia

“…The feared sequelae of recurrent haemarthrosis and chronic synovitis of the elbow are irreversible arthropathy, characterized by a hypertrophied radial head and ulnohumeral joint destruction that can ultimately lead to ankylosis with severe restriction of forearm mobility and debilitating pain . Complicating matters, destruction of other joints often accentuates the pain and progression of elbow arthropathy by making patients reliant on mobility aids such as crutches …”

“…For those patients who do experience recurrent haemarthrosis with worsening arthropathy, other measures are indicated. For mild and moderate haemophilic arthropathy of the elbow, conservative measures such as bracing and splinting along with exercises and stretching are appropriate …”

“…For patients with combined range of motion limitation (ie flexion‐extension and pronation‐supination) in whom other treatment modalities have been ineffective, especially in those with significant pain and few physical demands, total elbow arthroplasty (TEA) is an option . A review of the literature reveals a scarcity of data, with studies limited to case reports and small case series.…”

Interprosthetic humeral fracture revision using a tibial allograft total elbow prosthetic composite in a patient with hemophilia A : a case report

“…Severe arthropathy leads to pain, loss of range of motion, decreased strength and eventual disability. The joints most commonly affected are the knee, elbow and ankle, followed by the shoulder [1,2]. Total elbow arthroplasty (TEA) for patients with hemophilia results in better pain control, and an increased range of motion and function [2].…”

“…The joints most commonly affected are the knee, elbow and ankle, followed by the shoulder [1,2]. Total elbow arthroplasty (TEA) for patients with hemophilia results in better pain control, and an increased range of motion and function [2]. Complications are common after TEA for patients with hemophilia, including nerve palsies, deep vein thrombosis, infection, chronic pain, aseptic loosening, and periprosthetic fractures [1-3].…”