Total Hip Arthroplasty in A Young Patient with Bernard-Soulier Syndrome.
BACKGROUND
The management of patients with coagulopathic disorders undergoing orthopaedic surgery requires a dedicated, multi-disciplinary team with detailed perioperative planning. Bernard-Soulier Syndrome (BSS) is an extremely rare disorder, affecting 1 in 1 million individuals worldwide. It is caused by a deficiency in glycoprotein 1b-V-IX which is required for normal platelet-mediated clot formation. The deficiency results in prolonged bleeding time with high risk of spontaneous bleeds. Few reports exist in the clinical literature of BSS patients undergoing major surgery.


METHODS
A 40 year old, female with known BSS and developmental dysplasia of her left hip (DDH) was referred to us for consideration of left total hip arthroplasty (THA). Consultation with her Haematologist for pre-operative optimization of platelets and related clotting times together with detailed discussions of her intended anaesthesia protocol and surgery resulted in a successful operation with less than anticipated blood loss. She entered our rehabilitation program just one week after surgery.


CONCLUSIONS
BSS is an extremely rare bleeding disorder that puts patients at very high risk of blood loss following surgery. This is the first report that we are aware of describing a BSS patient undergoing a THA. A cohesive, highly specialized, multi-disciplinary team is crucial to the success of these patients.
Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario L8L 2X2 Canada.
Stuart
S
Bisland
Division of Orthopaedic Surgery, Juravinski Hospital, Hamilton, Ontario L8L 2X2 Canada.
Frank
F
Smith
Bernard-Soulier syndrome; Orthopaedic; Surgery; coagulopathy; hip arthroplasty; platelets; tranexamic acid