Revision Knee Arthroplasty in Patients with Inherited Bleeding Disorders: A Single-Center Experience

Abstract

BackgroundThe results of total knee arthroplasty (TKA) in patients with inherited bleeding disorders (IBDs) are poorer when compared with those in the general population, with a notably higher risk of complications and higher revision rates. Thus, revision procedures are becoming a growing concern in this group of patients. The aim of this study was to evaluate the results of revision TKA in patients with IBD.Material/MethodsA retrospective cohort study with longitudinal assessment of hemophilia patients scheduled for revision TKA between January 2010 and September 2015 was performed. The clinical status of the patients was assessed based on the Knee Society Score, and the Numeric Rating Scale was used to assess knee pain severity and patient satisfaction with the surgery. Radiological examination, post-operative complications, and reinterventions were recorded and analyzed.ResultsVery good results were obtained in all patients treated for aseptic loosening of the implant. However, inferior results were found in cases with infection. All patients operated on for aseptic loosening required only single-stage TKA, whereas patients with infection underwent multiple interventions. Complications were observed only in cases with infection.ConclusionsOur study clearly outlined the differences in results based on failure mode, with far inferior results obtained in cases with infection. Given the lack of data in this area as well as the high specificity of this population, further high-quality studies are needed.

Do patients with von Willebrand disease exhibit higher blood loss and revision rates in hip and knee arthroplasty? A case‐control study

“…Previous studies have included either a mixed cohort of patients with haemophilia and VWD or include other major orthopaedic surgeries such as total ankle arthroplasty or spinal surgery . The largest cohorts consist of patients with coagulopathy who have been identified from a commercial database.…”

“…Contemporary literature about the perioperative complications of hip and knee arthroplasty patients with bleeding disorders often include mixed cohorts of haemophilia and von Willebrand disease, making the results of these studies difficult to interpret. There is a paucity of data on the frequency and incidence of complications with isolated VWD .…”

Total knee arthroplasty in hemophilia A

“…Ten-year survival rates for knee arthroplasty implants have been reported to be as high as 94.3% [11]. However, investigations have found that TKA in these patients is associated with high rates of infection, intraoperative complications, and revision surgeries [6,[12][13][14][15][16][17][18]. The prevalence of infection after primary TKA in patients with hemophilia ranges from 0 to 17% in the literature, which is higher than the reported prevalence of 1-2% seen in TKA patients who do not have hemophilia [12].…”

Current Trend of Invasive Orthopaedic Interventions for People with Haemophilia in Romania: Single Centre Experience

“…Considering the outcomes and complications in the experience of our centre, they are comparable with those reported in the literature. [14][15][16] The higher frequency of our early bleeding events (23%) in the first period of observation, above all during emergency interventions, has been controlled, due to more generous replacement with factor concentrates in the second period (3.2%). 9 Infections, encountered in 13% of the cases, will have to remain under our strict attention.…”