Perioperative Period of a Hemophilia‐related Osteoarthropathy Therapeutic Regimen and Analysis of Complications

Li, Ye; Weng, Xisheng; Lin, Jianhao; Jin, Jin; Qian, Wenwei; Zhang, Baozhong; Gao, Peng; Zhai, Jiliang

doi:10.1111/os.12222

Cited by 8 publications

(13 citation statements)

References 53 publications

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“…Conservative approaches such as prophylactic factor replacement therapy help to decrease the occurrence of joint bleeding in young patients, but these therapies are typically expensive and have not shown satisfying effects in older patients with hemophilic arthropathy. These patients may eventually require orthopedic surgery. For patients with end‐stage arthropathy, total hip arthroplasty (THA) is an effective treatment when conservative approaches are ineffective.…”

Section: Introductionmentioning

confidence: 99%

Total Hip Arthroplasty in Hemophilia Patients: A Mid‐term to Long‐term Follow‐up

Zhai

Feng

et al. 2017

Orthopaedic Surgery

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Section: Introductionmentioning

confidence: 99%

Total Hip Arthroplasty in Hemophilia Patients: A Mid‐term to Long‐term Follow‐up

Zhai

Feng

et al. 2017

Orthopaedic Surgery

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“…The concentrations of blood coagulation factors were typically maintained at approximately 100% on the day of the surgery, approximately 80% during the first 3 postoperative days and approximately 60% during the fourth to sixth postoperative days. The dose was adjusted based on the target mentioned above, and 50 IU/kg was typically used as the initial dose; thereafter, the concentrations of coagulation factors were gradually decreased until discharge, as mentioned in our previous study 22 . All serum clotting factor levels were monitored daily during the first week postoperatively and once every other day thereafter until discharge.…”

Section: Methodsmentioning

confidence: 99%

Simultaneous bilateral total knee arthroplasty in patients with end-stage hemophilic arthropathy: a mean follow-up of 6 years

Jiang

Zhao

Feng

et al. 2018

Sci Rep

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To investigate the safety, cost-effectiveness, and clinical outcomes of simultaneous bilateral total knee arthroplasty (TKA) in hemophilic arthropathy (HA), the requirements for transfusions, complications, costs, hospital stays, Hospital for Special Surgery (HSS) knee scores, knee range of motion (ROM) and revision rates were compared between simultaneous bilateral and unilateral TKA in HA patients. A total of 36 patients and 54 knees were included. Compared to the unilateral group, the bilateral group did not require more transfusions (2.39 ± 3.13 vs 0. Hemophilic arthropathy (HA) is a common and occasionally inevitable complication that affects greater than 90% of patients with hemophilia before the age of 30 1 . Multiple joints, including the knee and hip, are often involved, leading to loss of function and permanent disabilities in end stage [2][3][4][5] (Fig. 1). The pathogenesis of HA begins with hemophilic synovitis induced by recurrent hemarthrosis, followed by joint erosion with cartilage damage and erosion of adjacent bones 6 . The most important approach to prevent HA involves eliminating intra-articular hemorrhage by regular factor replacement therapy (FRT) 7 . However, 70-80% of patients with hemophilia can not receive appropriate treatment and are thus at increased risk of developing HA 8 , and the knee joint is regarded as one of the most vulnerable joints 9 . Total knee arthroplasty (TKA) has been considered an optimal choice for treatment of HA [10][11][12][13][14][15][16] , and FRT is imperative in maintaining an adequate level of clotting factors to minimize blood loss perioperatively 8,17,18 . Given that HA of both knees is often involved, bilateral TKA is always unavoidable in the end stage. As staged bilateral TKA requires repeated clotting factor infusions that may induce the development of inhibitory against coagulation factors 19,20 as well as increases in hospitalization costs, simultaneous bilateral TKA may be considered a better treatment option. We conducted this retrospective study of 36 patients with a mean follow-up of 6 years to investigate the safety, cost-effectiveness, and medium-and long-term clinical outcomes of patients with end-stage HA receiving simultaneous bilateral TKA compared to unilateral TKA. We propose a hypothesis that the clinical results of simultaneous bilateral TKA were not inferior to unilateral TKA in HA patients. MethodsStudy design. We searched the database of a single center for patients older than 18 years with end-stage HA (Fig. 2) who were treated with TKA from April 2005 to April 2015. The inclusion criteria were as follows: a) patients with hemophilia who had incapacitating HA; b) only TKA was performed during one admission.

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“…So far, there are few cases [9] of anesthetic procedures with hemophilia B published in the literature submitted to general anesthesia, since previous studies have described the management hemophilia A and C. [3,6,7,10] Surgical treatment is a safe and reliable choice for addressing complications including hemophiliarelated osteoarthropathy given the implementation of effective measures for treatment during the perioperative period. [7] The single most important factor which contributes to the severity of hemophilia is the nature of mutations.…”

Section: Discussionmentioning

confidence: 99%

“…[7] The single most important factor which contributes to the severity of hemophilia is the nature of mutations. Even the phenotypically severe hemophilia cases can further be subclassified based on the type of mutations they carry.…”

Section: Discussionmentioning

confidence: 99%

“…[6] In any capacity, when these patients are submitted to surgical procedures, it merits uncommon consideration and a multidisciplinary group of wellbeing experts educated about the sickness, including qualified hematologist, surgeon and anesthesiologist. [3,7,8] The objective of this report was to describe the case of a patient with Hemophilia B underwent a femur fracture surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anesthetic Strategy for a Femur Fracture Surgery in a Patient with Hemophilia B (Factor IX Deficiency): A Case Report

Sakae¹

2016

Acad. Anesthesiol. Int.

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Perioperative Period of a Hemophilia‐related Osteoarthropathy Therapeutic Regimen and Analysis of Complications

Abstract: Surgical treatment is a safe and reliable choice for addressing complications including hemophilia-related osteoarthropathy given the implementation of effective measures for treatment during the perioperative period.

Cited by 8 publications

References 53 publications

Total Hip Arthroplasty in Hemophilia Patients: A Mid‐term to Long‐term Follow‐up

Total Hip Arthroplasty in Hemophilia Patients: A Mid‐term to Long‐term Follow‐up

Simultaneous bilateral total knee arthroplasty in patients with end-stage hemophilic arthropathy: a mean follow-up of 6 years

Anesthetic Strategy for a Femur Fracture Surgery in a Patient with Hemophilia B (Factor IX Deficiency): A Case Report

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