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Total knee arthroplasty in severe haemophilic patients under continuous infusion of clotting factors

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Haemophilic arthropathy is painful, invalidating and destructive. Authors report a prospective study of total knee arthroplasties in patients with severe haemophilia under continuous infusion of clotting factors. The purpose is to evaluate the benefits of continuous infusion of clotting factors regarding long-term functional improvement and radio-clinical results.

Methods

From 1998 to 2009, 20 total knee arthroplasties were implanted in 14 patients with a mean age of 36.5 years (24–56). A continuous infusion of anti-haemophilic factors was used and supervised by the physician of the Regional Haemophilia Treatment Centre (CRTH). Evaluation was clinical using the HSS and Oxford scores and radiological.

Results

One patient was lost to follow-up. Median follow-up is 66.5 months (6–134). Oxford score at latest follow-up is 42 (37–46). On revision, HSS score is 91 (84–96). Median flexion gain is 32.5° (−20; 75°). There is a median flexion contracture of 5° (0–15°) and a median extension improvement of 22.5°. We report 2 secondary infectious complications, concerning the same operated knee of a single patient. No post-operative haematoma was reported in our study.

Conclusion

Total knee arthroplasty in haemophilic arthropathy improves both the function and quality of life of this group of patients. Continuous infusion of clotting factors contributes significantly to these results, by allowing early and intensive rehabilitation, and offers security regarding haemorrhagic complications commonly described in the literature and that we have not encountered in our study.

Level of evidence

Therapeutic study, Level IV.

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References

  1. Arnold WD, Hilgartner MW (1977) Hemophilic arthropathy. Current concepts of pathogenesis and management. J Bone Joint Surg Am 59(3):287–305

    PubMed  CAS  Google Scholar 

  2. Augereau B, Travers V, Le Balch T, Witvoet J (1987) Total hip and knee arthroplasties in hemophilia. Apropos of 27 cases. Rev Chir Orthop Reparatrice Appar Mot 73(5):381–394

    PubMed  CAS  Google Scholar 

  3. Batorova A, Martinowitz U (2000) Intermittent injections versus continuous infusion of factor VIII in haemophilia patients undergoing major surgery. Br J Haematol 110(3):715–720

    Article  PubMed  CAS  Google Scholar 

  4. Burki H, von Knoch M, Heiss C, Drobny T, Munzinger U (1999) Lateral approach with osteotomy of the tibial tubercle in primary total knee arthroplasty. Clin Orthop Relat Res 362:156–161

    Article  PubMed  Google Scholar 

  5. Chaudhary R, Beaupre LA, Johnston DW (2008) Knee range of motion during the first 2 years after use of posterior cruciate-stabilizing or posterior cruciate-retaining total knee prostheses. A randomized clinical trial. J Bone Joint Surg Am 90(12):2579–2586

    Article  PubMed  CAS  Google Scholar 

  6. Chiang CC, Chen PQ, Shen MC, Tsai W (2008) Total knee arthroplasty for severe haemophilic arthropathy: long-term experience in Taiwan. Haemophilia 14(4):828–834

    Article  PubMed  CAS  Google Scholar 

  7. Clark CR, Rorabeck CH, MacDonald S, MacDonald D, Swafford J, Cleland D (2001) Posterior-stabilized and cruciate-retaining total knee replacement: a randomized study. Clin Orthop Relat Res 392:208–212

    Article  PubMed  Google Scholar 

  8. Cohen I, Heim M, Martinowitz U, Chechick A (2000) Orthopaedic outcome of total knee replacement in haemophilia A. Haemophilia 6(2):104–109

    Article  PubMed  CAS  Google Scholar 

  9. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80(1):63–69

    Article  PubMed  CAS  Google Scholar 

  10. Dingli D, Gastineau DA, Gilchrist GS, Nichols WL, Wilke JL (2002) Continuous factor VIII infusion therapy in patients with haemophilia A undergoing surgical procedures with plasma-derived or recombinant factor VIII concentrates. Haemophilia 8(5):629–634

    Article  PubMed  CAS  Google Scholar 

  11. Figgie MP, Goldberg VM, Figgie HE 3rd, Heiple KG, Sobel M (1989) Total knee arthroplasty for the treatment of chronic hemophilic arthropathy. Clin Orthop Relat Res 248:98–107

    PubMed  Google Scholar 

  12. Goddard NJ, Rodriguez-Merchan EC, Wiedel JD (2002) Total knee replacement in haemophilia. Haemophilia 8(3):382–386

    Article  PubMed  CAS  Google Scholar 

  13. Goldberg VM, Heiple KG, Ratnoff OD, Kurczynski E, Arvan G (1981) Total knee arthroplasty in classic hemophilia. J Bone Joint Surg Am 63(5):695–701

    PubMed  CAS  Google Scholar 

  14. Hicks JL, Ribbans WJ, Buzzard B, Kelley SS, Toft L, Torri G, Wiedel JD, York J (2001) Infected joint replacements in HIV-positive patients with haemophilia. J Bone Joint Surg Br 83(7):1050–1054

    Article  PubMed  CAS  Google Scholar 

  15. Hofmann AA, Plaster RL, Murdock LE (1991) Subvastus (Southern) approach for primary total knee arthroplasty. Clin Orthop Relat Res 269:70–77

    PubMed  Google Scholar 

  16. Huang CH, Liau JJ, Cheng CK (2007) Fixed or mobile-bearing total knee arthroplasty. J Orthop Surg Res 2:1

    Article  PubMed  CAS  Google Scholar 

  17. Innocenti M, Civinini R, Carulli C, Villano M, Linari S, Morfini M (2007) A modular total knee arthroplasty in haemophilic arthropathy. Knee 14(4):264–268. doi:10.1016/j.knee.2007.05.001

    Article  PubMed  CAS  Google Scholar 

  18. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  19. Karthaus RP, Novakova IR (1988) Total knee replacement in haemophilic arthropathy. J Bone Joint Surg Br 70(3):382–385

    PubMed  CAS  Google Scholar 

  20. Kjaersgaard-Andersen P, Christiansen SE, Ingerslev J, Sneppen O (1990) Total knee arthroplasty in classic hemophilia. Clin Orthop Relat Res 256:137–146

    PubMed  Google Scholar 

  21. Krackow KA, Jones MM, Teeny SM, Hungerford DS (1991) Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res 273:9–18

    PubMed  Google Scholar 

  22. Lachiewicz PF, Inglis AE, Insall JN, Sculco TP, Hilgartner MW, Bussel JB (1985) Total knee arthroplasty in hemophilia. J Bone Joint Surg Am 67(9):1361–1366

    PubMed  CAS  Google Scholar 

  23. Legroux-Gerot I (2003) Total knee arthroplasty in haemophilic arthropathy. Revue du rhumatisme 70:26–36

    Article  Google Scholar 

  24. Lehman CR, Ries MD, Paiement GD, Davidson AB (2001) Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use. J Arthroplast 16(3):330–335

    Article  CAS  Google Scholar 

  25. London JT, Kattlove H, Louie JS, Forster GL (1977) Synovectomy and total joint arthroplasty for recurrent hemarthroses in the arthropathic joint in hemophilia. Arthritis Rheum 20(8):1543–1545

    Article  PubMed  CAS  Google Scholar 

  26. Magone JB, Dennis DA, Weis LD (1986) Total knee arthroplasty in chronic hemophilic arthropathy. Orthopedics 9(5):653–657

    PubMed  CAS  Google Scholar 

  27. Marmor L (1977) Total knee replacement in hemophilia. Clin Orthop Relat Res 125:192–195

    PubMed  Google Scholar 

  28. Maruyama S, Yoshiya S, Matsui N, Kuroda R, Kurosaka M (2004) Functional comparison of posterior cruciate-retaining versus posterior stabilized total knee arthroplasty. J Arthroplast 19(3):349–353

    Article  Google Scholar 

  29. McCollough NC 3rd, Enis JE, Lovitt J, Lian EC, Niemann KN, Loughlin EC Jr (1979) Synovectomy or total replacement of the knee in hemophilia. J Bone Joint Surg Am 61(1):69–75

    PubMed  Google Scholar 

  30. McMillan CW, Webster WP, Roberts HR, Blythe WB (1970) Continuous intravenous infusion of factor VIII in classic haemophilia. Br J Haematol 18(6):659–667

    Article  PubMed  CAS  Google Scholar 

  31. Norian JM, Ries MD, Karp S, Hambleton J (2002) Total knee arthroplasty in hemophilic arthropathy. J Bone Joint Surg Am 84-A(7):1138–1141

    PubMed  Google Scholar 

  32. Post M, Telfer MC (1975) Surgery in hemophilic patients. J Bone Joint Surg Am 57(8):1136–1145

    PubMed  CAS  Google Scholar 

  33. Powell DL, Whitener CJ, Dye CE, Ballard JO, Shaffer ML, Eyster ME (2005) Knee and hip arthroplasty infection rates in persons with haemophilia: a 27 year single center experience during the HIV epidemic. Haemophilia 11(3):233–239

    Article  PubMed  CAS  Google Scholar 

  34. Ragni MV, Crossett LS, Herndon JH (1995) Postoperative infection following orthopaedic surgery in human immunodeficiency virus-infected hemophiliacs with CD4 counts < or = 200/mm3. J Arthroplast 10(6):716–721

    Article  CAS  Google Scholar 

  35. Rana NA, Shapiro GR, Green D (1986) Long-term follow-up of prosthetic joint replacement in hemophilia. Am J Hematol 23(4):329–337

    Article  PubMed  CAS  Google Scholar 

  36. Rodriguez-Merchan EC, Wiedel JD (2002) Total knee arthroplasty in HIV-positive haemophilic patients. Haemophilia 8(3):387–392

    Article  PubMed  CAS  Google Scholar 

  37. Silva M, Luck JV Jr (2005) Long-term results of primary total knee replacement in patients with hemophilia. J Bone Joint Surg Am 87(1):85–91

    Article  PubMed  Google Scholar 

  38. Small M, Steven MM, Freeman PA, Lowe GD, Belch JJ, Forbes CD, Prentice CR (1983) Total knee arthroplasty in haemophilic arthritis. J Bone Joint Surg Br 65(2):163–165

    PubMed  CAS  Google Scholar 

  39. Stieltjes N, Altisent C, Auerswald G, Negrier C, Pouzol P, Reynaud J, Roussel-Robert V, Savidge GF, Villar A, Schulman S (2004) Continuous infusion of B-domain deleted recombinant factor VIII (ReFacto) in patients with haemophilia A undergoing surgery: clinical experience. Haemophilia 10(5):452–458

    Article  PubMed  CAS  Google Scholar 

  40. Teigland JC, Tjonnfjord GE, Evensen SA, Charania B (1993) Knee arthroplasty in hemophilia. 5–12 year follow-up of 15 patients. Acta Orthop Scand 64(2):153–156

    Article  PubMed  CAS  Google Scholar 

  41. Thomason HC 3rd, Wilson FC, Lachiewicz PF, Kelley SS (1999) Knee arthroplasty in hemophilic arthropathy. Clin Orthop Relat Res 360:169–173

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France

    M. Rahmé, M. Ehlinger & F. Bonnomet

  2. Centre Régional de Traitement des Hémophiles et des Maladies Hémorragiques Constitutionnelles, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France

    A. Faradji, N. Gengenwin, J. Lecocq, J. Sibilia & F. Bonnomet

  3. Département d’Anesthésie et Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France

    N. Gengenwin

  4. Service de Médecine Physique et de Rééducation Fonctionnelle, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France

    J. Lecocq

  5. Service de Rhumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France

    J. Sibilia

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  1. M. Rahmé
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  2. M. Ehlinger
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Correspondence to M. Rahmé.

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Rahmé, M., Ehlinger, M., Faradji, A. et al. Total knee arthroplasty in severe haemophilic patients under continuous infusion of clotting factors. Knee Surg Sports Traumatol Arthrosc 20, 1781–1786 (2012). https://doi.org/10.1007/s00167-011-1766-8

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  • DOI: https://doi.org/10.1007/s00167-011-1766-8

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