Total knee arthroplasty for ankylosed knees in the extended position with hemophilia: a medium- and long-term single-center experience

Total knee arthroplasty (TKA) is one of the curative methods for patients with end-stage ankylosed knees. However, the existing methods are difficult to enable patients with hemophilic ankylosed knees to recover good functional activities.

Between January 2008 and December 2021, 22 male patients with ankylosed knees in the extended position due to hemophilia underwent TKA. The average age of the patients was 41.3 years (range, 19 to 52 years), and the average hospital stay was 33.4 days (range, 14 to 50 days). TKA was performed using quadriceps tendon Z-lengthening plasty, staged osteotomy, and comprehensive soft-tissue release. A variety of methods were used to evaluate the postoperative clinical outcomes and complications, including range of motion (ROM) assessment, Visual Analogue Scale (VAS), Knee Society Score (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

At the last follow-up, the average KSS increased from 75.14 ± 34.63 before surgery to 148.41 ± 27.74 (P < 0.001), the ROM increased from 0 to 86.14 ± 24.69 (P < 0.001), the WOMAC score changed from 28.05 ± 11.20 before surgery to 10.82 ± 11.00 (P < 0.001), and the average VAS score decreased from 2.86 ± 1.86 to 0.73 ± 1.20 (P < 0.001).

Although the recovery of range of motion is lower than normal and there is a relatively high incidence of complications, TKA can still significantly improve the flexion and extension functions, mobility, and quality of life of patients with ankylosed knees.