Total Knee Arthroplasty in Hemophilic Arthropathy
Hemophilic arthropathy of the knee is common among patients with hemophilia and is a major cause of severe joint pain and functional disability requiring total knee arthroplasty (TKA).
We evaluated TKA outcomes and complications with a special focus on prosthetic survival and infection. We retrospectively reviewed the medical records of 74 patients with chronic hemophilic arthropathy of the knee treated with TKA (N = 88) over a 13-year period. The same type of implant was used in all cases. Fourteen patients had 2-stage bilateral TKAs.
Mean patient age was 38.2 years (range, 24-73 years). Fourteen patients were positive for human immunodeficiency virus, and 32 for hepatitis C virus. Mean follow-up was 8 years (range, 1-13 years). The prosthetic survival rate with implant removal for any reason regarded as final endpoint was 92%. Causes of TKA failure were prosthetic joint infection (6.8%) and aseptic loosening (2.2%).
Clinical outcomes of the primary TKAs in this series were good prosthetic survival and excellent pain relief. TKA infection continues to be a major concern for patients with hemophilia relative to patients without hemophilia.
Our study had 2 main limitations. First, it was a retrospective case series evaluation with the usual issues of potential inaccuracy of medical records and information bias. Second, the study did not include a control group.
Conclusion
The primary TKAs performed in our patients with hemophilia have had a good prosthetic survival rate. Even though such a result is slightly inferior to results in patients without hemophilia, our prosthetic survival rate is not significantly different from the rates reported in other, younger patient subsets. Late periprosthetic infections are a major concern, and taking precautions to avoid hematogenous spread of infections during factor concentrate infusions is strongly encouraged.
