Total Knee Arthroplasty in Hemophiliacs: Gains in Range of Motion Realized beyond Twelve Months Postoperatively

Abstract

BackgroundHemophiliacs have extrinsic tightness from quadriceps and flexion contractures. We sought to examine the effect of a focused physical therapy regimen geared to hemophilic total knee arthroplasty.MethodsTwenty-four knees undergoing intensive hemophiliac-specific physical therapy after total knee arthroplasty, at an average age of 46 years, were followed to an average 50 months.ResultsFor all patients, flexion contracture improved from -10.5 degrees preoperatively to -5.1 degrees at final follow-up (p = 0.02). Knees with preoperative flexion less than 90 degrees were compared to knees with preoperative flexion greater than 90 degrees. Patients with preoperative flexion less than 90 degrees experienced improved flexion (p = 0.02), along with improved arc range of motion (ROM) and decreased flexion contracture. For those patients with specific twelve-month and final follow-up data points, there was a significant gain in flexion between twelve months and final follow-up (p = 0.02).ConclusionsHemophiliacs with the poorest flexion benefited most from focused quadriceps stretching to a more functional length, with gains not usually seen in the osteoarthritic population. This data may challenge traditional views that ROM gains are not expected beyond 12-18 months.

Meta‐analysis: outcomes of total knee arthroplasty in the haemophilia population

“…No systematic review or meta‐analysis exists addressing outcomes such as functional limitations, ROM or complication rate after TKAs in PWH. Currently, numerous studies address these ideas, but many are limited based on the use of outdated surgical techniques and factor replacement strategies, small patient samples, or non‐standardized data collection (knee score outcomes, ROM values) . Consequently, determining TKA effectiveness and overall functional improvements in PWH is difficult.…”

Soft tissue releasing and serial casting for management of flexion contracture after primary total knee arthroplasty in a patient with hemophilia

“…Range of motion after operation is an important factor for outcomes, and it is correlated with quality of life [ 10 ]. The main cause of flexion contracture deformity is the chronic process of recurrent bleeding into the knee joints, combined with hyper vascularized synovitis, leading to soft tissue contraction that produces flexion deformity [ 1 , 2 , 11 ]. Surgical intervention of knee flexion contracture in hemophilia following TKA other than revision TKA is limited.…”

Evaluation of outcomes of suction drainage in patients with haemophilic arthropathy undergoing total knee arthroplasty

“…In our study, overall postoperative ROM improvement was significant compared with preoperative measurements. An organized rehabilitation programme is essential to achieve ideal functional outcomes . Our study showed a noteworthy improvement in functional and clinical knee scores in both groups after TKA.…”

“…Recurrent episodes of haemarthrosis in the joints result in a sequence of iron deposition, synovial inflammation and cartilage degradation. This chemical process accompanied by mechanical stress intensifies a state of hyaline cartilage wear and synovial fibrosis and hypertrophy, which denotes HA . HA of the knee presents with joint deformity and impaired painful range of motion which has a significant effect on quality of life and functional status of the young population involved.…”