title: Total knee arthroplasty in severe haemophilic patients under continuous infusion of clotting factors.
abstract: OBJECTIVE
  Haemophilic arthropathy is painful, invalidating and destructive. Authors report a prospective study of total knee arthroplasties in patients with severe haemophilia under continuous infusion of clotting factors. The purpose is to evaluate the benefits of continuous infusion of clotting factors regarding long-term functional improvement and radio-clinical results.
  
  
  METHODS
  From 1998 to 2009, 20 total knee arthroplasties were implanted in 14 patients with a mean age of 36.5 years (24-56). A continuous infusion of anti-haemophilic factors was used and supervised by the physician of the Regional Haemophilia Treatment Centre (CRTH). Evaluation was clinical using the HSS and Oxford scores and radiological.
  
  
  RESULTS
  One patient was lost to follow-up. Median follow-up is 66.5 months (6-134). Oxford score at latest follow-up is 42 (37-46). On revision, HSS score is 91 (84-96). Median flexion gain is 32.5° (-20; 75°). There is a median flexion contracture of 5° (0-15°) and a median extension improvement of 22.5°. We report 2 secondary infectious complications, concerning the same operated knee of a single patient. No post-operative haematoma was reported in our study.
  
  
  CONCLUSIONS
  Total knee arthroplasty in haemophilic arthropathy improves both the function and quality of life of this group of patients. Continuous infusion of clotting factors contributes significantly to these results, by allowing early and intensive rehabilitation, and offers security regarding haemorrhagic complications commonly described in the literature and that we have not encountered in our study.
  
  
  METHODS
  Therapeutic study, Level IV.
authors: Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France. dr.mrahme@gmail.com
authors: M
authors: M
authors: Rahmé
authors: M
authors: M
authors: Ehlinger
authors: A
authors: A
authors: Faradji
authors: N
authors: N
authors: Gengenwin
authors: J
authors: J
authors: Lecocq
authors: J
authors: J
authors: Sibilia
authors: F
authors: F
authors: Bonnomet
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D003029:Coagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001779:Blood Coagulation Factors; D003029:Coagulants