title: Haemophilic knee arthropathy: long-term outcome after total knee replacement.
abstract: OBJECTIVE
  The objective of this study was to evaluate the long-term outcome and prosthetic survival of primary total knee arthroplasty in haemophilic patients. It was hypothesized that the infection and revision rate are higher and the outcome inferior when compared with patients without haemophilia.
  
  
  METHODS
  Between 1985 and 2004, forty-three consecutive primary total knee replacements were performed in thirty haemophilic patients. These patients' charts were reviewed retrospectively. Twenty-five patients (34 knees) were available for clinical and radiological follow-up. The outcome was assessed using the Knee Society score, WOMAC and Kaplan-Meier survivorship analysis.
  
  
  RESULTS
  An haematogenous infection occurred in two patients. In three patients, component revision was needed: two because of an infection and one because of a mechanical failure. After a mean follow-up of 9.6 years (2-20), 94% of the patients rated their result as either excellent or good. At time of follow-up, the Knee Society Score averaged 73.3 points (range, 29-100) and showed a significant gain (p < 0.001) compared to preoperative. Flexion contracture could be reduced significantly (p < 0.001) from 18.1° preoperatively to 8.4° at follow-up, whereas flexion remained unchanged. When infection or any component replacement was set as endpoints, the 10 years prosthetic survival was 90 and 86%, respectively.
  
  
  CONCLUSIONS
  Total knee arthroplasty in haemophilic patients is a reliable treatment that results in pain relief and functional improvement with a low risk of postoperative infection. However, neither the postoperative infection rate nor the functional result does reach the same level as in a population not affected by haemophilia.
  
  
  METHODS
  IV.
authors.affiliation: Division of Knee Surgery, Department of Orthopaedics, University of Zurich Balgrist, Forchstrasse 340, 8008, Zürich, Switzerland.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Zingg
authors.forename: Sandro F
authors.initials: SF
authors.lastname: Fucentese
authors.forename: Willy
authors.initials: W
authors.lastname: Lutz
authors.forename: Brigit
authors.initials: B
authors.lastname: Brand
authors.forename: Nadja
authors.initials: N
authors.lastname: Mamisch
authors.forename: Peter P
authors.initials: PP
authors.lastname: Koch
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult