Knee haemophilic arthropathy care in Chile: Midterm outcomes and complications after total knee arthroplasty

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia Vol. 26; no. 4; pp. e179 - e186
• Main Authors: Oyarzun, Andrés, Barrientos, Cristian, Barahona, Maximiliano, Martinez, Álvaro, Soto‐Arellano, Verónica, Courtin, Carolina, Cruz‐Montecinos, Carlos
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.07.2020
• Subjects: Adult; Aged; Arthroplasty (knee); Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Blood Coagulation Factors - administration & dosage; Case-Control Studies; Chile - epidemiology; Female; Follow-Up Studies; haemophilic knee arthropathy; Hemophilia A - complications; Hemophilia A - drug therapy; Humans; Incidence; Infections - epidemiology; Joint Diseases - complications; Joint Diseases - surgery; Joint replacement surgery; Joint surgery; Knee Joint - physiopathology; Knee Joint - surgery; Male; Middle Aged; Patients; Postoperative Complications - epidemiology; Range of Motion, Articular - physiology; Reoperation - statistics & numerical data; simultaneous bilateral TKA; Statistical analysis; Supplements; Surgery; Survival; TKA complications; TKA survival; total knee arthroplasty; Treatment Outcome; Chile; total knee arthroplasty; simultaneous bilateral TKA; TKA survival; haemophilic knee arthropathy; TKA complications
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/hae.14004

Introduction Total knee arthroplasty (TKA) can improve knee function in the general population, but challenges arise for TKA use in haemophilic patients (HPs). Aim This study aimed to evaluate the midterm clinical experience of a single medical centre in TKA in HPs. Methods We performed a case series of consecutive TKAs from 2007 to 2013 in HPs. All patients received coagulation factor supplementation according to the institutional protocol. Surgery was performed without a tourniquet by a standard midline medial parapatellar approach. We compared the range of motion (ROM) and flexion contracture before surgery and 1‐year postoperative using paired Wilcoxon‐non‐parametric test (P < .05 was considered significant). The need for revision surgery was considered TKA survival failure. Results Forty‐one HP/60 TKAs were reviewed (19 cases were bilateral). Preoperative median ROM and flexion contracture was 75° (range, 0°‐95°) and 20° (range, 5°‐80°), respectively. The postoperative median ROM increased to 83° (range, 45°‐110°), and median flexion contracture decrease to 0° (range, 0°‐40°) a statistically significant difference (P < .01). Postoperative median clinical Knee Society Score (KSS) and functional KSS were 88 (range, 59‐97) and 100 (range, 30‐100), respectively. Six patients required revision (6.66%) due to infection. TKA survival at 5 years was 92% (range, 82%‐96%). Conclusion This study supports that TKA improves function and ROM in haemophilic knee arthropathy. The protocol of coagulation factors used in this cohort is valid as no related complications were reported. A higher incidence of complications, especially infections, must be expected compared with a TKA in non‐HPs.