Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost‐effective procedure?

Mortazavi, Seyed Mohammad Javad; Haghpanah, Babak; Ebrahiminasab, M. M.; Baghdadi, Taghi; Hantooshzadeh, Razieh; Toogeh, Gholamreza

doi:10.1111/hae.12832

Cited by 17 publications

(24 citation statements)

References 20 publications

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“…In previous studies, the five- and ten-year prosthetic survival rates were approximately 90% for TKA surgery in HA patients 24 , 25 , which is similar to the results of our study. We experienced a total of 3 revisions in the mean follow-up of 6 years among 54 prostheses, for a revision rate of 5.6%.…”

Section: Discussionsupporting

confidence: 92%

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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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Section: Discussionsupporting

confidence: 92%

“…Previous studies have reported no difference in improvement of joint function between simultaneous and staged bilateral or unilateral TKA 21 , 23 , 25 . Our results were consistent with these studies.…”

Section: Discussionmentioning

confidence: 70%

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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“…These findings seem to imply that simultaneous multiple joint replacement for patients with HA would lead to higher risks compared with single joint replacement. On the contrary, Mortazavi et al [ 13 ] compared the prognosis of 8 patients who underwent simultaneous bilateral TKA and 19 patients who underwent unilateral TKA and concluded that simultaneous bilateral TKA is a safe and cost-effective approach without augmenting the incidence of complications in patients with hemophilia. Thes et al [ 14 ] conducted a retrospective case–control study and found that simultaneous bilateral TKA is associated with significantly lower costs of coagulation factors and longer hospital stay compared with staged bilateral TKA, but no significant difference in clinical outcome was noted.…”

Section: Discussionmentioning

confidence: 99%

Hemophilic arthropathy in a patient with multi-joint replacement

Zhu

Xia

et al. 2018

Medicine

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Rationale:Hemophilic arthropathy (HA) is a crucial morbidity and a major cause of joint pain and disability in patients with hemophilia A. Surgical methods, such as total joint arthroplasty, are of vital importance for end-stage HA treatment, but the feasibility and effects of multi-joint replacement surgery remain debatable.Patient concerns:A 24-year-old patient with advanced HA presented multiple joint pain. Physical examination revealed joint tenderness, swelling, and limited activity. Radiographs revealed bilateral knee joints and left elbow joint damage with joint space narrowing, articular facet erosion, and bone deformation.Diagnoses:The patient was diagnosed with hemophilic arthropathy with multi-joint lesions.Interventions:The key points of this case include arthropathy in multiple joints and the management of simultaneous total multi-joint arthroplasty. We performed bilateral total knee arthroplasty and total left elbow arthroplasty simultaneously after adequate preparations. Special attention was paid to factor VIII infusion, hemorrhage control, and other safety precautions perioperatively.Outcomes:After the surgery, no complications, such as infection or aseptic loosening, occurred, and the joints functioned well at follow-up.Lessons:The surgical outcome and safety of multi-joint replacement for HA are attested. Simultaneous multi-joint arthroplasty can ameliorate the quality of life for patients with hemophilia A.

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“…Many patients with hemophilia suffer from end-stage arthropathy involving multiple joints 2,5,6,15 . There has been a trend to perform multiple surgical procedures during a single operating session for patients with hemophilia when surgical intervention has been indicated 9,16 . Because a major fraction of the financial burden of surgical treatment for patients with hemophilia is the cost of factor replacement, the benefits of multiple procedures in patients with hemophilia are twofold.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple joint procedures are defined as any combination of major surgical procedures for the treatment of end-stage arthropathy in patients with hemophilia (including total knee arthroplasty, total hip arthroplasty, and ankle arthrodesis) during a single anesthetic episode. In some studies, simultaneous bilateral total knee arthroplasty has been proposed for patients with hemophilia as a way to reduce costs, improve rehabilitation, and accelerate the return to normal life 7-9 . Multiple joint procedures also can reduce the event of intensive treatment with clotting factor concentrate compared with staged single joint procedures.…”

mentioning

confidence: 99%

Comparison of 90-Day Complication Rates and Cost Between Single and Multiple Joint Procedures for End-Stage Arthropathy in Patients with Hemophilia

Feng

Xiao

Gao

et al. 2018

JBJS OA

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Background: Multiple joint procedures during a single anesthetic episode have been proposed for patients with hemophilia as a way to reduce cost. The postoperative 90-day complication rate and the cost distribution between multiple joint procedures and single joint procedures for patients with hemophilia have not been well studied. Methods: Between January 1996 and December 2016, 124 patients underwent 177 surgical procedures (total knee arthroplasty, total hip arthroplasty, and ankle arthrodesis) for the treatment of hemophilic end-stage arthropathy. Forty-eight patients (39%) underwent multiple joint procedures during 1 hospitalization, and 76 patients (61%) underwent single joint procedures. The medical records were retrospectively reviewed. The patients were evaluated for complications within 90 days postoperatively and the cost during hospitalization. Risk factors related to complications were further analyzed. Results: Twenty-seven of the 124 patients experienced 29 complications within 90 days postoperatively, representing a complication rate of 16.4% for all procedures. The patients who had undergone multiple joint procedures had a higher rate of surgical complications than those who had undergone a single joint procedure (14.6% vs. 3.9%; p = 0.039). The patients who had had multiple joint procedures had similar rates of hematological complications (8.3% vs. 9.2%; p = 0.867) and total complications (31.3% vs. 18.4%; p = 0.100) compared with those who had had a single joint procedure. There was no difference between the patients who had had multiple joint procedures and those who had had a single joint procedure with regard to the cost of the coagulation factor (p = 0.212). Conclusions: The performance of multiple joint procedures during a single anesthetic episode is a safe approach for patients with hemophilia with end-stage arthropathy, with no substantial increase in the 90-day complication rate in comparison with that following a single joint procedure. The performance of multiple joint procedures under a single anesthetic episode can save cost and is more cost-effective when managing patients with hemophilia who have end-stage arthropathy. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost‐effective procedure?

Cited by 17 publications

References 20 publications

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

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

Hemophilic arthropathy in a patient with multi-joint replacement

Comparison of 90-Day Complication Rates and Cost Between Single and Multiple Joint Procedures for End-Stage Arthropathy in Patients with Hemophilia

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