Trends of outcomes and healthcare utilization following orthopaedic procedures in adults with haemophilia: A 3‐decade retrospective review

Abstract

Introduction Haemophilic arthropathy is a serious complication of haemophilia often requiring surgical intervention. It is unclear whether advances in comprehensive care are associated with a reduction in orthopaedic interventions and peri‐procedural resource utilization. Aim To determine temporal patterns of orthopaedic interventions in persons with haemophilia (PWH), and evaluate changes in healthcare utilization and outcomes. Methods In this Canadian multicentre retrospective cohort study, adult PWH from Northern Alberta and British Columbia who underwent orthopaedic procedures (1990‐2018) were included. Temporal changes in the type of procedures, length of stay (LOS), factor utilization and outcomes were examined. Results : Sixty‐five patients (78% haemophilia A) underwent 102 surgeries at a median age of 46.3. Of the 46 severe PWH, 28 (61%) were on prophylaxis at time of surgery. The proportion of total knee arthroplasties (TKA) declined over time (56% 1990–1999, 51% 2000–2009, 27% 2010–2018), with a concomitant rise in ankle arthrodesis (0% 1990–1999, 18% 2000–2009, 27% 2010–2018). Over time, PWH underwent orthopaedic procedures at an older age (P = .02). There was a significant reduction in perioperative factor VIII utilization (P = .003) and median LOS (P < .0001). Major bleeds, prosthetic joint infections and thrombosis were not observed in the last decade. Conclusion In the last three decades, there was a decline in the proportion of TKA, likely reflecting the impact of widespread use of tertiary prophylaxis. However, ankle arthrodesis rates increased, suggesting that higher trough levels may be required to prevent ankle arthropathy. We observed a significant reduction in LOS and factor utilization, reflecting improvements in perioperative management.

Mid‐to long‐term postoperative outcomes of ankle joint fusion in patients with haemophilia: A systematic review

“…Excluding three studies, 24,28,30 the mean postoperative follow up period across the other 14 studies was 5.7 years (SD 5.0) with a range of .33 to 33.4 years.…”

“…A total of 17 eligible studies [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] were identified including two non-randomised interventional studies, 13 retrospective non-interventional studies and two case reports. Four of the noninterventional studies were comparative.…”

“…As shown in Table 1, 14 studies had a total of 170 patients with three studies 20,22,24 not clearly defining the number of patients included. A total of 271 ankle fusions were performed across the 17 eligible studies.…”

“…Four studies 20,24,27,31 did not clearly delineate the haemophilia class or severity for the ankle fusions performed, or had mixed data. Excluding the three studies 17,21,25 that did not report on the perioperative correction of clotting factor activity levels, the other 14 studies reported correction of clotting factor activity levels during surgery according to their institutional guidelines.…”

Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

“…Adequate intra- and postoperative care to avert postoperative residual contracture is needed in PWH [ 52 ]. In the last 30 years, there has been a decrease in the rate of TKA, probably indicating the impact of extensive utilization of tertiary hematological prophylaxis [ 53 ].…”