Total knee replacement in patients with haemophilia: the Scottish experience.
BACKGROUND
Patients with haemophilia commonly develop arthropathy secondary to recurrent haemarthroses. Although modern treatment with replacement coagulation factors has reduced the prevalence of end-stage arthropathy, total joint replacement is still required in a small group of patients. These patients may be at higher risk of complications and the outcome of surgery may not be comparable to reports of outcomes of total joint replacement in the general population. The purpose of this study was to describe the change in function in patients undergoing total knee replacement for haemophilic arthropathy.


METHODS
Patients undergoing total knee arthroplasty in a tertiary centre had prospective evaluations of patient reported outcome measures and range of movement. Their post-operative function was evaluated in a combined orthopaedic-haematology clinic. Eight male patients underwent 13 total knee replacements from 1999 to 2007 and were followed up for a median of 78 months (range 17-116).


RESULTS
The median Oxford knee score improved from 45.5 pre-operatively to 28 (p = 0.049). There was a similar improvement in SF-12 physical (p = 0.017) and Knee Society scores (objective p = 0.001; function p = 0.002). Four total knee replacements were performed in patients with inhibitor antibodies and were treated with recombinant activated factor VIIa. These patients had reduced range of movement (p = 0.047). No patients suffered deep infection.


CONCLUSIONS
Total knee replacement in patients with haemophiliac arthropathy resulted in improvement in range of movement and function. The presence of factor VIII inhibitors resulted in reduced range of movement, but similar patient reported outcome measures.
Specialist Registrar, Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
P J
PJ
Jenkins
I
I
Ekrol
G M
GM
Lawson
D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D015942:Factor VIIa / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006467:Hemophilia A / Q000150:complications / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D011994:Recombinant Proteins / Q000627:therapeutic use; D012606:Scotland / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome
D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa
Total knee replacement; haemophilia; haemophilic arthropathy