title: Haemophilic arthropathy: long-term outcomes in 107 primary total knee arthroplasties.
abstract: BACKGROUND
  Arthropathy of the knee is a frequent complication in patients with severe bleeding disorders leading to considerable pain and disability. Total knee arthroplasty (TKA) provides marked pain relief. However, a modest functional outcome and a high number of complications due to prosthetic infection and loosening are reported. Data on long-term outcomes are scarce, and most case series include few patients. We have studied clinical outcomes and complications of TKAs with special emphasis on prosthetic survival and periprosthetic infection.
  
  
  METHODS
  A consecutive series of 107 TKAs in 74 patients with haemophilic arthropathy were retrospectively reviewed. Follow-up was mean 11.2 years (range 0.8-33.1 years).
  
  
  RESULTS
  Five- and 10-year survival rates, with component removal for any reason as the end point, were 92% and 88%, respectively. Twenty-eight TKAs were removed after median 10 years (range 0.8-28 years). The most common cause of failure was aseptic loosening (14 knees) and periprosthetic infection (seven knees). The overall infection rate was 6.5%. The mean postoperative drop in haemoglobin levels was 4.3 g/dL (range 0.5-9.4) with a significant difference between haemophilia A patients with and without inhibitor (6.3 g/dL (range 3.6-9.4) versus 3.7 g/dL (range 0.5-8.1) (p<0.001). A painless knee was reported in 93% of the TKAs at the latest follow-up.
  
  
  CONCLUSIONS
  The medium and long-term results of primary TKA in a large haemophilic population show good prosthetic survival at five and 10 years with an excellent relief of pain. Periprosthetic infection is still a major concern compared to the non-haemophilic population.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. Electronic address: marianne.westberg@oslo-universitetssykehus.no.
authors.forename: Marianne
authors.initials: M
authors.lastname: Westberg
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Paus
authors.affiliation: Department of Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Research Institute of Internal medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Pål Andrè
authors.initials: PA
authors.lastname: Holme
authors.affiliation: Department of Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Geir E
authors.initials: GE
authors.lastname: Tjønnfjord
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000209:etiology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D025861:Blood Coagulation Disorders, Inherited / Q000150:complications*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000209:etiology / Q000601:surgery*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006454:Hemoglobins
keywords: Arthropathy; Haemophilia; Long term follow-up; Total knee arthroplasty