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Factors influencing the long‐term outcome of primary total knee replacement in haemophiliacs: a review of 116 procedures at a single institution
Author(s) -
Solimeno Luigi P.,
Mancuso Maria E.,
Pasta Gianluigi,
Santagostino Elena,
Perfetto Samantha,
Mannucci Pier Mannuccio
Publication year - 2009
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2009.07613.x
Subject(s) - medicine , surgery , total knee replacement , haemophilia , range of motion , arthropathy , arthroplasty , knee replacement , prosthesis , orthopedic surgery , osteoarthritis , alternative medicine , pathology
Summary Total knee replacement (TKR) is a safe treatment for alleviating pain and restoring physical function in end‐stage arthropathy of the knee. First reports of TKR in haemophiliacs date back to the mid‐1970s, however detailed information on long‐term outcome is scarce. This study evaluated factors influencing the outcome of 116 primary TKRs performed consecutively over 14 years at a single institution. Haemostatic management is discussed in patients with and without inhibitors. Orthopaedic outcome was measured by using the Hospital for Special Surgery knee‐rating scale, knee flexion contracture and range of motion. At the end of follow‐up period (median duration: 5·1 years) 96 prostheses (83%) were still in place with a 7‐year removal‐free survival of 81%, similar between human immunodeficiency virus‐positive and ‐negative patients and lower in inhibitor than non‐inhibitor patients (44% vs. 87%; P < 0·05). Sixteen prostheses (14%) were removed for infection (nine) or aseptic loosening (seven) after a median of 4·5 years. Presence of inhibitors, continuous infusion, cementless prostheses and different primary surgeons were associated with an increased risk of infection; however, after adjustment, only primary surgeon was confirmed as an independent risk factor. These results show that TKR represents a safe and effective procedure in haemophiliacs if performed by a highly experienced surgeon.