Long-term follow-up after osteotomy for haemophilic arthropathy of the knee.
In this study the long-term value of corrective osteotomy around the knee was evaluated by means of clinical and radiographic parameters. Between 1974 and 1984 we performed 52 corrective osteotomies in the vicinity of the knee on patients affected by haemophilic arthropathy. Forty-two patients (45 osteotomies) were adequately followed-up at an average 11.6 years postoperatively. Using the clinical score of the Advisory Committee of the World Federation of Haemophilia, 38 patients showed a postoperative improvement, five remained clinically unchanged and two showed deterioration. Range of motion of the knee joint did not significantly improve postoperatively. The radiographic Pettersson score showed only a marginal decrease by an average 0.003 points at the time of follow-up. Only one patient needed subsequent joint replacement of both knees, on the left side 13 years after osteotomy and on the right side 8 years after osteotomy. Even in cases of marked radiographic joint destruction, corrective osteotomy shows acceptable long-term clinical results, underlining the feasibility of this management option in the treatment of haemophilic arthropathy of the knee. Although moderate cartilage degenerations in the femoropatellar complex and in the contralateral compartment can be tolerated, this therapy should primarily be contemplated for those patients where damage is unicompartmental and a corresponding axial deviation is found. Particularly the younger patient can benefit from this treatment option in that joint replacement may possibly wholly be avoided or at least postponed to a later stage of life.
Wallny
T
T
Department of Orthopaedics, University of Bonn, Bonn, Germany. wallny@uni-bonn.de
Saker
A
A
Hofmann
P
P
Brackmann
H H
HH
Nicolay
C
C
Kraft
C N
CN
D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome