title: Perioperative management of hemophilia patients receiving total hip and knee arthroplasty: a complication report of two cases.
abstract: It has been recognized that perioperative hemostasis management after joint-replacement surgery for hemophilia patients is complicated and cumbersome, due to the necessity of rigorous monitoring for clotting-factor levels throughout the infusion. Between 2005 and 2014, we examined seven patients with hemophilia A (ten joints: six hips and four knees) receiving total hip or knee arthroplasty (THA or TKA) for hemophilic arthropathy. One male patient (31 years old) showed an intra-articular hematoma formation after THA (case 1). In another male patient (46 years old) receiving TKA, the postoperative trough factor VIII level became lower significantly than reference levels (80%-100% for the 5-10 postoperative days) recommended by the guidelines from the Japanese Society on Thrombosis and Hemostasis, despite sufficient coagulant based on the guidelines being administered (case 2). In the latter patient, deep infection and hematoma formation were observed postoperatively. In this article, we provide a detailed clinical report regarding these two complication cases at the early postoperative periods, and the management of bleeding control for hemophilia patients is discussed.
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tateiwa
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan ; Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tsunehito
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kubo
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Masaoka
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Shishido
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Yamamoto
keywords: arthroplasty; clotting factor VIII levels; hematoma; hemophilia A; infection