Robot-assisted total hip arthroplasty following gene therapy for hemophilia a arthropathy: a case report

Hemophilia A (HA) arthropathy poses a significant clinical challenge, particularly in achieving perioperative hemostasis and surgical precision. Accounting for the majority of hemophilia cases, HA frequently leads to severe secondary joint damage. Although gene therapy holds promise, its clinical application in HA remains limited by challenges to durable efficacy. Crucially, the transient efficacy and unpredictable pharmacokinetics of gene therapy have not been evaluated in major orthopedic surgeries with a high potential for bleeding, such as total hip arthroplasty (THA).

To our knowledge, this is the first documented case of robot-assisted (RA)-THA performed after gene therapy for severe HA-associated hip arthropathy, including a detailed surgical protocol and a postoperative follow-up of over six months. The patient received hemophilia gene therapy 56 weeks prior to surgery. Crucially, no exogenous FVIII supplementation was required preoperatively or intraoperatively. A minimal amount of FVIII was administered postoperatively. No abnormal bleeding events occurred throughout the perioperative period. The patient maintained normal coagulation status, achieved excellent wound healing, and demonstrated excellent functional recovery.

This pioneering case demonstrates the potential safety and efficacy of combining gene therapy with minimally invasive RA-THA for HA hip arthropathy. The integrated approach significantly reduced dependence on exogenous FVIII and enabled precise anatomical reconstruction.