Bilateral total knee arthroplasty in a patient with hemophilia A, high inhibitor titre and aneurysma spurium of the popliteal artery. A case report.
The authors report on bilateral simultaneous knee arthroplasty in a 40-year-old male patient with haemophilia A, high inhibitor titre and an aneurysma spurium of the right popliteal artery. Both knees showed a fixed flexion deformity of 20 degrees. To build up haemostasis, treatment with activated prothrombin complex concentrate (APCC) and recombinant activated factor seven (rFVIIa) was initiated preoperatively. A tourniquet was used on both sides during the operation and factor VIII (FVIII) was administered to further correct coagulopathy. On the eleventh postoperative day the patient complained of increasing pain and pressure in the right knee. An ultrasound suggested aneurysm, which was confirmed by substraction angiography. Under the protection of rFVIIa the aneurysm could be coiled and further rehabilitation was uneventful. At one year post-op the patient presented a range of motion of 90/5/0 degrees for both knees and had returned to full time office work. This case indicates that haemophiliacs with high antibody titre and destruction of both knees can be operated on in one session in order to diminish the operative risk of two consecutive surgical procedures, thus allowing an effective rehabilitation programme. Because of the significant frequency of popliteal aneurysms, preoperative angiography is recommended.
Frauchiger
Lars Henrik
LH
Department of Orthopaedic Surgery, University of Berne, Switzerland.
Harstall
Roger
R
Kajahn
Jennifer
J
Anderson
Suzanne
S
Eggli
Stefan
S
D000328:Adult; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D019774:Blood Coagulation Factor Inhibitors / Q000097:blood*; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D004621:Embolization, Therapeutic; D005169:Factor VIII / Q000008:administration & dosage*; D015942:Factor VIIa / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000097:blood* / Q000628:therapy*; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000097:blood / Q000601:surgery*; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000628:therapy*; D011300:Preoperative Care; D016059:Range of Motion, Articular; D011994:Recombinant Proteins / Q000008:administration & dosage
D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; D005169:Factor VIII; C103587:recombinant FVIIa; C065655:anti-inhibitor coagulant complex; D015942:Factor VIIa