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Published on: July 22, 2021
Total knee replacement in haemophilic arthropathy
1Department of Orthopaedics and Haemophilia Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain. rmerchan@arrakis.es
The Journal of Bone and Joint Surgery. British Volume
|February 27, 2007
Summary
Total knee replacement in hemophilia patients shows excellent mechanical survival and good outcomes. This reproducible procedure is safe, even for HIV-positive individuals and those with inhibitors, with a lower infection rate than previously reported.
Area of Science:
- Orthopedic Surgery
- Hematology
Background:
- Hemophilia patients often experience debilitating joint damage, necessitating surgical intervention.
- Total knee replacement (TKR) presents unique challenges in hemophilia due to bleeding risks and potential comorbidities like HIV.
Purpose of the Study:
- To report the outcomes of primary total knee replacement in a cohort of hemophilia patients.
- To evaluate the safety and efficacy of TKR in hemophiliacs, including those with HIV and inhibitors.
Main Methods:
- Retrospective review of 35 primary TKRs in 30 hemophilia patients (1996-2005).
- Data collected included patient demographics, hemophilia type, HIV status, CD4 count, and Knee Society scores.
- Surgical technique and prosthesis were standardized.
Main Results:
- Excellent or good results were achieved in 94% of knees.
- The 7.5-year survival rate of the prosthesis was 97%.
- Infection rates were similar between HIV-positive and negative patients; only one late deep infection occurred.
Conclusions:
- Primary total knee replacement is a safe and reproducible procedure in hemophilia patients.
- Outcomes are favorable even in HIV-positive patients with CD4 counts > 200 mm³ and those with inhibitors.
- The observed low infection rate may be attributed to improved HIV management and antibiotic-loaded cement use.
