[Orthopedic interventions in patients with hemophilia]

Patients with severe hemophilia A or B and von Willebrand Syndrome have recurrent joint bleedings, which can occur spontaneously or as a result of trauma. Resorption of intraarticular blood induces an inflammation of the synovium and cartilage damage, finally leading to severe changes of the joint with complete destruction. This process is called hemophilic arthropathy. After failure of substitution and intensive conservative therapy after 3 to 6 months, a synovectomy or a synoviorthesis are indicated. In some cases the progression of hemophilic arthropathy cannot be stopped and requires total joint arthroplasty. In some cases joint motion cannot be saved and requires arthrodesis. This paper presents methods and results of different operation concepts in patients (n = 39) with hemophilia or von-Willebrand-syndrome. Especially by implanting total knee (n = 17) and total hip joints (n = 6) we obtained very good functional results after an average follow-up period of 33.3 respectively 56.3 months. In a series of synovectomie of the knee performed before 1990 (n = 7) and followed after an average period of 21.4 years the progression of hemophilic arthropathy could not be stopped. In a second series of synovectomy of the knee performed after 1990 (n = 5) and follow after an average period of 5.6 years, at least the mobility of the knee could be saved. Only one patient of a series of supra- and infracondylar osteotomie (n = 9) achieved the wanted result. Further we performed 6 operations on the hindfoot with satisfying results.