Outcome after total knee arthroplasty in haemophilic patients with stiff knees.
BACKGROUND
Advanced haemophilic arthropathy of the knee is associated with progressive joint stiffness. Results after total knee arthroplasty (TKA) in stiff knees are considered to be inferior compared to those with less restricted preoperative range of motion (ROM). There is only very limited data on the results of primary TKA in haemophilic patients with stiff knees.


OBJECTIVE
The purpose of this retrospective study was to evaluate the clinical outcome after TKA performed in haemophilic patients with preoperative ROM of 50° or less.


METHODS
Twenty one patients (23 knees) undergoing TKA with stiff knees were retrospectively evaluated. Mean follow-up was 8.3 years (range, 2-25). Clinical assessment included ROM, degree of flexion contracture and complication rate. Functional evaluation and pain status were assessed using the Knee Society's Scoring System (KSS).


RESULTS
Range of motion improved from 26.7° preoperatively to 73.0° postoperatively. Flexion contracture decreased from 21.7° to 8.3°. KSS increased from 22.9 to 72.9 points. Evaluation of pain revealed a decrease from 8.4 points preoperatively to 2.1 points postoperatively. All these differences were statistically significant (P < 0.005). The complication rate was 8.7% including one late periprosthetic infection, and one aseptic implant loosening. Nine patients who required VY-quadricepsplasty for knee exposure developed a mean postoperative extensor lag of 7°.


CONCLUSIONS
Total knee arthroplasty in haemophilic patients presenting with stiff knees results in significant improvement of function and reduction in pain. Although the clinical outcome is inferior compared to nonstiff knees reported in the literature, joint replacement surgery can be successfully performed in this particular group of patients.
Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
A C
AC
Strauss
Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
J
J
Schmolders
Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
M J
MJ
Friedrich
Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
R
R
Pflugmacher
Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
M C
MC
Müller
Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany.
G
G
Goldmann
Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany.
J
J
Oldenburg
Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
P H
PH
Pennekamp
D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000150:complications* / Q000473:pathology; D002836:Hemophilia B / Q000150:complications* / Q000473:pathology; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome
arthropathy; haemophilia; stiff knee; total knee arthroplasty