[Total knee arthroplasty and perioperative management of hemophilic arthritis].
OBJECTIVE
To evaluate the clinical results and perioperative management of primary total knee arthroplasty (TKA) in hemophilic patients.


METHODS
From February 1997 to February 2006, the data of 6 total knee arthroplasty performed in 4 hemophilic patients was reviewed retrospectively. The values of coagulation factor were maintained at suitable level by monitoring the activity of the factors and their inhibitors during perioperative period. The mean follow-up time was 4.4 years, knee society score and the last postoperative radiographs were recorded.


RESULTS
After TKA, the hemophilic patients felt pain of knee relieved, the knee function was improved, but the range of motion increased limitedly. At the early post-operative stage, 3 knees in 2 patients with hemarthrosis or muscle bleeding, 1 of the 2 patients complicated with formation of inhibitor of factor VIII and healing problem in 1 knee after TKA, 1 patient with transient paralysis of the common peroneal nerve, 1 patient with venous circulation insufficiency crisis, but no compartment syndrome. In the late stage after TKA, 1 patient with hemarthrosis of both elbows, but no late infection, loosening, displacement and fracture of the prosthesis in the 6 knees.


CONCLUSIONS
Total knee arthroplasty could alleviate knee pain and improve joint function in advanced severe hemophilic arthritic patients. It is important to monitor the activity and inhibitors of coagulation factor VIII or IX, which could decrease the early and late postoperative complications.
Sun
Tie-zheng
TZ
Arthritis Clinic and Research Center, People's Hospital, Peking University, Beijing 100044, China.
Lü
Hou-shan
HS
Guan
Zhen-peng
ZP
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000209:etiology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome