Total knee arthroplasty in chronic hemophilic arthropathy

Nine total knee arthroplasties were performed in seven patients with either Hemophilia A (factor VIII deficiency) or Hemophilia B (factor IX deficiency) and followed for an average of 52 months. A total condylar prosthesis was used in eight virgin knees and a stemmed variable axis prosthesis was used in one revision case. All knees demonstrated the severe joint destruction and cartilage erosion characteristic of chronic hemophilic arthropathy. The average age at operation was 32 years. All patients were evaluated using the knee disability assessment of The Hospital for Special Surgery. All knees were postoperatively rated as either excellent or good. Pain, function, and range of motion were markedly improved. Postoperative radiographic alignment averaged 4 degrees of valgus with half of the virgin knees demonstrating 1 mm or less of non-progressive tibial radiolucency without clinical loosening. The only complication was hemarthrosis from 37 to 59 months postoperatively. This was thought to be secondary to trauma to residual synovium. Total knee arthroplasty in the hemophiliac is a viable alternative to conventional methods of treatment for chronic arthropathy and expectations for pain relief and functional gain can be high.