title: Factors influencing the long-term outcome of primary total knee replacement in haemophiliacs: a review of 116 procedures at a single institution.
abstract: Total knee replacement (TKR) is a safe treatment for alleviating pain and restoring physical function in end-stage arthropathy of the knee. First reports of TKR in haemophiliacs date back to the mid-1970s, however detailed information on long-term outcome is scarce. This study evaluated factors influencing the outcome of 116 primary TKRs performed consecutively over 14 years at a single institution. Haemostatic management is discussed in patients with and without inhibitors. Orthopaedic outcome was measured by using the Hospital for Special Surgery knee-rating scale, knee flexion contracture and range of motion. At the end of follow-up period (median duration: 5.1 years) 96 prostheses (83%) were still in place with a 7-year removal-free survival of 81%, similar between human immunodeficiency virus-positive and -negative patients and lower in inhibitor than non-inhibitor patients (44% vs. 87%; P < 0.05). Sixteen prostheses (14%) were removed for infection (nine) or aseptic loosening (seven) after a median of 4.5 years. Presence of inhibitors, continuous infusion, cementless prostheses and different primary surgeons were associated with an increased risk of infection; however, after adjustment, only primary surgeon was confirmed as an independent risk factor. These results show that TKR represents a safe and effective procedure in haemophiliacs if performed by a highly experienced surgeon.
authors.affiliation: Haemophilic Arthropathy Treatment Centre M.G. Gatti Randi, CTO Hospital, Milan, Italy.
authors.forename: Luigi P
authors.initials: LP
authors.lastname: Solimeno
authors.forename: Maria E
authors.initials: ME
authors.lastname: Mancuso
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Pasta
authors.forename: Elena
authors.initials: E
authors.lastname: Santagostino
authors.forename: Samantha
authors.initials: S
authors.lastname: Perfetto
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D019317:Evidence-Based Medicine / Q000379:methods*; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000097:blood / Q000382:microbiology / Q000601:surgery*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006490:Hemostatics