Total knee arthroplasty for the treatment of chronic hemophilic arthropathy.
Total knee arthroplasty (TKA) for hemophilic (factor VIII deficiency) arthropathy is a complex and demanding procedure with a high complication rate. However, the long-term benefits have not previously been reported. This study reviews 19 TKAs performed for hemophilic arthropathy that were followed for a minimum of 5.5 years and an average of 9.5 years. At present, 13 knees have good or excellent results, and six knees rate as poor or failures. Those patients with excellent results have maintained good pain relief and function. Four of the six failures were among the first seven arthroplasties performed, when only 80% factor VIII coverage was used during the perioperative period. Since the use of 100% factor VIII coverage was instituted, the failure rate has declined. Ten of the 19 knees suffered complications, including one deep infection, six superficial skin necroses, three nerve palsies, seven postoperative bleedings, and one transfusion reaction. Six of the seven knees operated on under 80% factor VIII coverage had complications. Once 100% factor VIII coverage was instituted, the only complications included one skin necrosis and three postoperative bleedings. The roentgenographic failure rate has remained high with progressive roentgenographic lucencies in 13 of 19 tibial components, associated with component shift in three knees. While these roentgenographic findings have not necessarily correlated with clinical results, they are disturbing and may portend future failures. However, pain relief and improved function are maintained at longer follow-up times. The best results were obtained under 100% factor VIII coverage using a posterior stabilized prosthesis and patellar resurfacing.
Figgie
M P
MP
Hospital for Special Surgery, New York, NY 10021.
Goldberg
V M
VM
Figgie
H E
HE
Heiple
K G
KG
Sobel
M
M
D000328:Adult; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007592:Joint Diseases / Q000209:etiology / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging; D007720:Knee Prosthesis; D008297:Male; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D013997:Time Factors