[Knee endoprosthesis implantation in hemophiliac arthropathy: results, problems and complications]

In the final stages of haemophilic arthropathy of the knee joint, the preservation of walking ability is only possible by joint replacement. Fibrotic ancylosis and severe deformities, being mostly bilaterally, make the joint reconstruction difficult and impair the results. The purpose of this study was to evaluate the results of total knee replacement (TKR) in haemophilia.

From 1990 to 1998, 14 TKR in 7 patients with severe haemophilia were performed. The mean age at operation was 47.3 years (range, 27-62 years). The mean follow-up period was 3.7 years (range, 1-7 years). The TKR was performed bilaterally at the same time in 6 cases. In 1 case, the bilateral TKR was done one after another with 6 months interval. In 10 knee joints, an unconstrained or semi-constrained surface replacement system was used. In 4 joints, a hinged prosthesis was required.

The range of motion (extension-flexion) was improved from 0-23-69 degrees preoperatively to 0-4-88 degrees at follow-up. The mean HSS Score increased from 34.5 points preoperatively to 77.9 points at follow-up. Perioperatively, no haemorrhages or early infections were observed. In 1 case, 6 years postoperatively a late infection of the hinged knee prosthesis occurred. A two-stage-exchange of the prosthesis was performed. Aseptic loosenings of prosthetic components were not observed.

The TKR in haemophilia is technically demanding and requires a consequent perioperative F-VIII or F-IX substitution. A bilateral simultaneous implantation is useful. The indication for TKR has to be strict because of the higher risks and requires a close cooperation with the haemostaseologist.