The risk of elective orthopaedic surgery for haemophilia patients: Japanese single-centre experience

Abstract

Haemophilic arthropathy causes pain and a severely restricted range of motion, and results in a significant reduction in quality of life. When conservative treatments have failed, orthopaedic surgery is recommended for these patients with severe haemophilic arthropathy. However, surgery for haemophilia patients is challenging due to high complication rate such as infection, delayed wound healing and mortality. The aim of this study was to evaluate the incidence of early complications and identify preoperative risk factors of surgery for haemophilia patients. We report a series of haemophilia patients undergoing elective orthopaedic surgery between 2006 and 2012. During this period, 119 surgeries in 81 patients were prepared and 118 surgeries in 80 patients were actually performed. Four deep bacterial infections and four delayed wound healings occurred within 6 months postoperatively. One patient died preoperatively and four patients died postoperatively. Only the presence of inhibitor was a significant risk factor for infection. We found no risk factor related to delayed wound healing. Our data revealed alkaline phosphatase, albumin, platelet, alpha-fetoprotein, presence of ascites and child classification C as predictors of perioperative mortality following elective orthopaedic surgery. Our role is to identify potential patients who present with risk factors for complications and attempt to seek the best determination of treatment strategy for these people.

Commentary: Total joint replacement in inhibitor-positive haemophilia: Long-term outcome analysis in fifteen cases

“…However, in our experience, the quality of life can be improved via diminished pain, even under situations of stationary contractures. Also, the risk for deep infection seemed smaller than reported previously 2,3 .…”

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

“…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 …”

“…Of note, the assessment of perioperative mortality is complicated even as a short‐term outcome measure in surgery in patients with haemophilia, particularly due to underlying comorbidities related to viral disorders (HIV, HCV) in older patients with haemophilia likely to undergo major orthopaedic procedures. The study by Hirose of 118 procedures in 80 patients reported an overall mortality within 6 months of 6.2% (five patients) . However, this included one patient who died preoperatively, and the principal drivers of mortality were associated with severe liver disorders due to HCV hepatitis.…”

“…The study by Hirose of 118 procedures in 80 patients reported an overall mortality within 6 months of 6.2% (five patients). 32 However, this included one patient who died preoperatively, and the principal drivers of mortality were associated with severe liver disorders due to HCV hepatitis.…”

Perioperative Management of Hemophilia a Using Recombinant Factor VIII in Patients Undergoing Major or Minor Surgery

“…In contrast, though symptomatic improvement may be achieved with the latest antiviral drugs in HIV-infected patients, a cure is not possible. Particularly with respect to hepatitis C, postoperative death cases are significantly higher among cases characterized as Child classification B, those with low ascites and albumin, and those with thrombocytopenia [9]. Confirmation of these conditions is important for surgical decisions.…”