Seventy‐two total knee arthroplasties performed in patients with haemophilia using continuous infusion

Abstract

The multidisciplinary approach and the homogeneous management of our large cohort allowed the achievement of excellent functional results. Our results confirmed previously reported data on the safety and efficacy of CIFC in situations requiring intensive factor replacement, such as TKR surgery.

Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices

“…Length of stay in hospital for perioperative management is not only affected by clinical characteristics (eg surgery complexity, existence of treatment complications) but can also be affected by local protocols arising from funding restrictions; ultimately, this encouragespreoperative factor dosing in outpatients and early discharge for outpatient dosing of additional doses. The appropriate use of coagulation factor products combined with regular assessments at a haemophilia (or bleeding‐disorder) comprehensive care centre, supplemented with symptomatic support (eg physiotherapy around orthopaedic surgery), was shown to assist the majority of patients in recovering from surgery …”

“…There are varying outcome measures that have been used to assess the success of perioperative management in haemophilia patients: haemostatic outcome, rate of treatment complications (eg postoperative bleeding, wound infections) and treatment mortality …”

“…Sixteen retrospective studies focused on management and outcomes of orthopaedic surgeries. In one study of TKR, a number of postoperative complications were frequently reported such as bleeding, infection and stiffness (Table ; Appendix : Table ) …”

Continuous Infusion of Coagulation Products in Hemophilia

“…Many reports demonstrated CI to be safe and hemostatically effective for all indications mentioned above, including the most demanding surgical procedures [1,2,[4][5][6][7]20,[34][35][36][37][38]. Most recently Takedani [37], Rahmé et al [38], and Chevalier et al [39] reported on successful use of CI in 28, 20, and 72 total knee replacements, respectively. A prospective controlled study comparing CI and BI for major surgery using protocols that were similar regarding the surgical technique and postoperative target minimum levels demonstrated that efficacy and safety were better with CI than with BI in terms of minimum factor levels achieved, blood loss (as measured by a decrease in hemoglobin level), blood transfusion requirements, and bleeding complications ( [24].…”

“…Initial plasma levels as high as 50 IU/mL and CI maintenance doses around 50 μg/kg/h have been suggested, and the clinical efficacy of such a high dose CI for major surgery was demonstrated [28,46]. Recently, the results of the first prospective randomized study comparing the BI and CI in inhibitor of pdFIX may also differ significantly from that of rFIX (4.25 vs 7.71 mL/kg/h, respectively) [39]. Similarly, Uprichard et al [33] in the setting of CI observed a clearance of rFIX 30% greater than that of pdFIX.…”