Total joint arthroplasty in the treatment of advanced hemophilia A arthropathy

doi:10.3969/j.issn.2095-4344.1942

Abstract

Abstract:

BACKGROUND: Hemophilia arthritis is the dysfunction of multiple joints caused by hemophilia, in which the incidence of hip and knee joint is high. Total joint arthroplasty is an effective method for the treatment of hemophilia arthritis, which can improve the quality of life of patients, reduce the dysfunction of affected limbs and prolong the life span of patients.

OBJECTIVE: To investigate the clinical efficacy of total joint arthroplasty in the treatment of advanced hemophilia A arthropathy.

METHODS: The clinical data of 14 patients with advanced hemophilia A arthropathy (11 knees and 9 hips) from June 2015 to February 2019 were analyzed retrospectively. Totally 11 knees underwent total knee arthroplasty, and 9 hips underwent total hip arthroplasty. All patients were male with a mean age of 38.6±9.9 years. One case received intraoperative transfusion of 300 mL, and two cases received blood transfusion of 200 mL after operation. In the perioperative period, the coagulation factor replacement therapy was used to select (500 IU) recombinant human coagulation factor Ⅷ, perioperatively. The detection of factor Ⅷ inhibitors was zero. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Knee function after total knee arthroplasty was assessed using the Hospital for Special Surgery Knee Score and the American Knee Society Score. Hip function was evaluated after total hip arthroplasty by Harris score. Visual analogue score and the activity of the factor Ⅷ were compared before and after operation. Bleeding, infection and prosthetic loosening were observed.

RESULTS AND CONCLUSION: (1) Fourteen patients were followed-up for 12-45 months. No complications such as revision, prosthetic loosening or joint infection were found in all patients after operation. (2) The Hospital for Special Surgery score was increased from (30.1±9.5) preoperatively to (82.1±10.7) after one-year follow-up. The clinical score of Knee Society Score was increased from (29.1±15.4) preoperatively to (89.3±7.0) after one-year follow-up, and the functional score of Knee Society Score was increased from (18.6±13.6) preoperatively to (72.3±16.6) after one-year follow-up. The Harris score of total hip arthroplasty was increased from (34.6±10.7) preoperatively to (85.8 ±4.8) after one-year follow-up (P < 0.05). The visual analogue score was decreased from (6.0±2.4) preoperatively to (1.0±0.9) after one-year follow-up, and the activity of the factor Ⅷ was increased from (1.9±2.0)% preoperatively to (108.6±20.7)% on the first day after operation (P < 0.05). (3) The clinical efficacy of total joint arthroplasty under coagulation factor substitution for advanced hemophilia A arthropathy is outstanding. It can significantly improve the joint function, correct deformation, reduce pain, and improve the long-term quality of life of the patients.

Key words: hemophilia A arthropathy, total knee arthroplasty, total hip arthroplasty, follow-up, pain, coagulation factor

CLC Number:

R459.9|R318|R684.3

Gao Qiang, Liu Wei, Li Jiale, Jing Juehua, Yao Yunfeng. Total joint arthroplasty in the treatment of advanced hemophilia A arthropathy[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(36): 5741-5746.

Figures/Tables 3

References

[1]Badulescu OV, Tudor R, Friedl W, et al. Efficiency of tranexamic acid in management of surgical orthopedic bleeding in patients with haemophilia. Revistadechimie. 2017; 68(3):627-630.

[2]Liddle AD, Rodriguez-Merchan EC. Evidence-based management of the knee in hemophilia. JBJS Rev. 2017;5(8): e12.

[3]Rodriguez-Merchan EC, Valentino LA. Orthopedic disorders of the knee in hemophilia: A current concept review. World J Orthop.2016;7(6):370-375.

[4]Moore MF,Tobase P, Allen DD. Meta-analysis: outcomes of total knee arthroplasty in the haemophilia population. Haemophilia. 2016;26(4):e275-e285.

[5]Song SJ, Bae JK,Park CH, et al. Mid- term outcomes and complications of total knee arthroplasty in haemophilic arthropathy: A review of consecutive 131 knees between 2006 and 2015 in a single institute. Haemophilia. 2018;24(2):299-306.

[6]Chen FY,Yang FE,Chen Q. Total knee arthroplasty for the treatment of hemophilic arthropathy of the knee. Zhongguo Gu Shang. 2011;24(12):1001-1004.

[7]Xie J, Hu Q, Huang Z, et al. Comparison of three routes of administration of tranexamic acid in primary unilateral total knee arthroplasty: Analysis of a national database.Thromb Res.2018;173:96-101.

[8]Lin ZX, Woolf SK. Safety, efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery. Orthopedics. 2016; 39(2):119-130.

[9]Carulli C, Felici I, Martini C, et al. Total hip arthroplasty in haemophilic patients with modern cementless implants. J Arthroplasty. 2015;30(10):1757-1760.

[10]Parsa A, Azizbaig Mohajer M, Mirzaie M. Hip arthroplasty in haemophilia: a systematic review. HIP Int. 2018;28(5):459-467.

[11]Wu GL, Zhai JL, Feng B, et al. Total hip arthroplasty in hemophilia patients:a mid-term to long-term follow-up. Orthop Surg. 2017;94:359-364.

[12]Livnat T, Budnik I, Levy-Mendelovich S, et al. Combination of hemostatic therapies for treatment ofpatients with hemophilia A and inhibitors. Blood Cells Mol Dis. 2017;66:1-5.

[13]Rodriguez-Merchan EC. Aspects of current management: orthopaedic surgery in haemophilia.Haemophilia.2012;18(1): 8-16.

[14]Moore MF,Tobase P, Allen DD. Meta-analysis: outcomes of total knee arthroplasty in the haemophilia population. Haemophilia.2016;22(4):e275-e285.

[15]Rodriguez-Merchan EC,Valentino LA. Orthopedic disorders of the knee in hemophilia: a current concept review. World J Orthop. 2016;7(6):370-375.

[16]Anderson JA, Mason JA, Halliday B. Clinical outcomes and patient satisfaction following total hip and knee arthroplasty in patients with inherited bleeding disorders: A 20-year single-surgeon cohort. Haemophilia.2018;24(5):786-791.

[17]Carulli C,Rizzo AR, Innocenti M. Hip arthropathy in haemophilia.J Clin Med. 2017;6(4).pii:E44.

[18]Lee SH, Rhyu KH, Cho YJ, et al. Cementless total hip arthroplasty for haemophilic arthropathy:follow-up result of more than 10 years. Haemophilia. 2015;21(1):e54-e58.

[19]Solimeno LP, Pasta G. Knee and ankle arthroplasty in hemophilia. J Clin Med. 2017;6(11).pii:E107.

[20]Strauss AC, Schmolders J, Friedrich MJ,et al. Outcome after total knee arthroplasty in haemophilic patients with stiff knees. Haemophilia. 2015;21(4):e300-e305 .

[21]Ernstbrunner L, Hingsammer A, Catanzaro S, et al. Long-term results of total knee arthroplasty in haemophilic patients: an 18-year follow-ups. Knee Surg Sports Traumatol Arthrosc. 2017;25(11):3431-3438 .

[22]Santos Silva M, Rodrigues-Pinto R, Rodrigues C,et al. Long-term results of total knee arthroplasty in hemophilic arthropathy.J Orthop Surg (Hong Kong).2019;27(1): 2309499019834337.