title: Orthopaedic outcome of total knee replacement in haemophilia A.
abstract: A consecutive series of 16 patients with classical Haemophilia underwent 21 total knee replacements between 1989 and 1997 for haemophilic arthropathy. The patients received Factor VIII replacement therapy via continuous infusion, and fibrin glue was used to facilitate haemostasis. Three different types of prostheses were used. A follow-up evaluation was undertaken between 2 and 10 years after the operation (mean 5.6 years) and two patients with infection were excluded. Knee scores averaged 77.5 (pre-operative 24. 1) and functional scores averaged 84.4 (preoperative 23.2). There were no cases with aseptic loosening of the prosthesis. Complications included one early deep infection controlled by conversion of the TKR into an arthrodesis, one case of late septic loosening that had to be re-operated upon, one case of patellar dislocation, two cases of stiff knee (fibro-arthrosis) that required manipulation under anaesthesia, one postoperative hepatitis, one superficial infection treated by incision and drainage and four febrile patients with no clear source of infection, who responded to antibiotics alone. In conclusion, TKR offers haemophilic patients a long-lasting improvement of their quality of life and we therefore advocate its use with the appropriate indications.
authors.affiliation: The Orthopaedic Division, Sheba Medical Center, Tel-Hashomer, Israel; National Haemophilia Center, Sheba Medical Center, Tel-Hashomer, Israel. ilanco@hotmail.com
authors.forename: I
authors.initials: I
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Heim
authors.forename: U
authors.initials: U
authors.lastname: Martinowitz
authors.forename: A
authors.initials: A
authors.lastname: Chechick
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D005169:Factor VIII / Q000276:immunology / Q000627:therapeutic use; D015942:Factor VIIa / Q000008:administration & dosage; D005334:Fever / Q000209:etiology; D005355:Fibrosis; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000209:etiology / Q000601:surgery; D006467:Hemophilia A / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D007717:Knee / Q000000981:diagnostic imaging / Q000473:pathology; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D007518:Isoantibodies; D005169:Factor VIII; D015942:Factor VIIa