Clinical outcomes and patient satisfaction following total hip and knee arthroplasty in patients with inherited bleeding disorders: A 20‐year single‐surgeon cohort

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia Vol. 24; no. 5; pp. 786 - 791
• Main Authors: Anderson, J. A., Mason, J. A., Halliday, B.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.09.2018
• Subjects: Adult; Aged; arthroplasty; Arthroplasty (knee); Arthroplasty, Replacement, Hip - methods; Arthroplasty, Replacement, Knee - methods; Bleeding; Clinical outcomes; Female; haemophilia; haemophilic arthropathy; Hemophilia; Hemorrhage - complications; Hemorrhage - pathology; Hip; Humans; inherited bleeding disorders; Joint surgery; Knee; Male; Middle Aged; Pain; Patient Satisfaction; Quality of Life - psychology; Surgery; Total hip arthroplasty; total hip replacement; total knee replacement; Treatment Outcome; Young Adult; haemophilia; total hip replacement; total knee replacement; haemophilic arthropathy; inherited bleeding disorders; arthroplasty
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/hae.13559

Introduction Persons with haemophilia and other inherited bleeding disorders are prone to disabling joint arthropathy frequently requiring arthroplasty for end‐stage joint disease. Higher complication rates and more modest post‐operative functional outcomes have previously been described. Aim To evaluate the clinical outcomes and patient satisfaction of persons with inherited bleeding disorders (predominantly haemophilia) undergoing total hip and knee replacement. Methods Retrospective, single‐centre cohort study with longitudinal assessment of patients with inherited bleeding disorders who underwent total hip and knee replacement over a 20‐year period. Eligible patients were clinically assessed with Harris Hip Score (HHS), Knee Society Score (KSS), pain visual analogue scale (VAS) and a patient satisfaction questionnaire. Results Thirty‐one patients (48 joints) met the inclusion criteria. Mean age at surgery was 49.3 years (SD: 13.1, range 21‐75 years) with a mean follow‐up of 9.33 years (1.7‐19.3). The majority (26/31) of patients had haemophilia A, predominantly severe haemophilia A (22/26). Reported pain levels were low, and patient satisfaction was high. Joint‐specific outcome scores were “good” to “excellent” in 67% of total hip replacement patients and 92% of total knee replacement patients. A low complication rate was observed, with 2 patients requiring revision surgery and 4 patients requiring re‐operation without implant revision. Conclusion Arthroplasty is a reliable procedure in patients with inherited bleeding disorders with end‐stage hip or knee arthropathy. The overall complexity of this group is highlighted, and the need for multidisciplinary care is emphasised.