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Knee arthroplasty in hemophilic arthropathy
H C Thomason1, F C Wilson, P F Lachiewicz
1Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill 27599, USA.
Clinical Orthopaedics and Related Research
|April 2, 1999
Summary
Total knee arthroplasty in severe hemophilia patients showed a high complication rate, particularly loosening and infection in those with human immunodeficiency virus (HIV). This suggests caution when considering total knee replacement for hemophilic arthropathy, especially in HIV-positive individuals.
Area of Science:
- Orthopedic Surgery
- Hematology
- Infectious Diseases
Background:
- Severe hemophilia often leads to end-stage arthropathy, causing significant pain.
- Total knee arthroplasty (TKA) is considered for pain relief in such cases.
- Few studies address long-term TKA outcomes in hemophilia patients.
Purpose of the Study:
- To evaluate the long-term results of TKA in patients with severe hemophilia.
- To assess complication rates, including infection and component loosening.
- To investigate the impact of human immunodeficiency virus (HIV) serostatus on TKA outcomes.
Main Methods:
- Retrospective review of 23 TKAs in 15 severe hemophilia patients (Factor VIII or IX deficiency).
- Follow-up ranged from 4 to over 15 years.
- Outcomes assessed using Hospital for Special Surgery (HSS) and Knee Society radiographic scoring systems.
- Analysis of infection rates and component fixation.
Main Results:
- Overall poor functional outcomes: 1 excellent, 3 good, 2 fair, 17 poor based on HSS scores.
- High rates of component loosening: 13/23 femoral and 15/23 tibial components showed some degree of loosening.
- Significant complication rate: 4 deep infections (all in HIV-positive patients), 1 revision for aseptic loosening.
- Seven of eight deceased patients were HIV-positive.
Conclusions:
- TKA in severe hemophilia patients is associated with a high incidence of complications, including loosening and deep infection.
- HIV seropositivity significantly increases the risk of complications following TKA in this population.
- While TKA may alleviate pain in hemophilic arthropathy, careful patient selection and risk assessment are crucial, especially for HIV-positive individuals.