[Knee replacement arthroplasty in hemophilia: results, complications and predictive elements of their occurrence].
OBJECTIVE
Determine the effect of supplementation rate and HIV disease on results and complications in total knee replacement in hemophilia.


METHODS
Twenty-nine total knee arthroplasties were performed in twenty-one disabled patients with major hemophilia, from 1986 to 1995. All the implants were postero-stabilised prostheses. The average age of patients at the time of surgery was 40.8 years, average follow-up was 4.8 years. Preoperatively, all patients complained of severe pain, with stage IV or V arthropathies, according to Arnold classification. Twelve patients were HIV sero-positive.


METHODS
Functional and radiological results, and postoperative complication rate was analyzed in relation with mean deficient factor titer, HIV status, and periarticular soft tissues quality.


RESULTS
Results of the total knee arthroplasties, as determined by the IKS scoring system, were 86.2/100 for Pain, Motion, Stability and 88.7/100 for function. The average gain of motion was twenty-four degrees. One patient required amputation, and one an arthrodesis after deep infection. Postoperative complications, in addition to infections, included intra articular bleeding in nine patients, one peroneal nerve palsy, two instances of inhibition to factor VIII, four superficial skin necrosis, and one important gastric bleeding which required surgical treatment. A high titer of deficient factor (> 70 per cent of the average normal concentration) seemed correlated with a lower complication rate. In this study, surgery had no incidence on HIV disease evolution.


CONCLUSIONS
Authors emphasize the high level of postoperative infections (6/29), particularly in patients with HIV infection (5/12) frequently after superficial skin necrosis, as well as the high postoperative complication rate.


CONCLUSIONS
However good results were finally observed, association of HIV disease, insufficient deficient factor concentration, and altered quality of periarticular soft tissues increased particularly complication occurrence. With particular attention to these factors, and despite frequent complications, total knee arthroplasty in hemophilia restores good function and allows patients satisfaction.
Vastel
L
L
Service de chirurgie orthopédique A, Hôpital Cochin, Paris.
Courpied
J P
JP
Sultan
Y
Y
Kerboull
M
M
D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006679:HIV Seropositivity / Q000150:complications*; D006395:Hemarthrosis / Q000209:etiology; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000209:etiology; D011859:Radiography; D012307:Risk Factors; D013997:Time Factors