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Haemophilic knee arthropathy: long-term outcome after total knee replacement

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

Abstract

Purpose

The objective of this study was to evaluate the long-term outcome and prosthetic survival of primary total knee arthroplasty in haemophilic patients. It was hypothesized that the infection and revision rate are higher and the outcome inferior when compared with patients without haemophilia.

Methods

Between 1985 and 2004, forty-three consecutive primary total knee replacements were performed in thirty haemophilic patients. These patients’ charts were reviewed retrospectively. Twenty-five patients (34 knees) were available for clinical and radiological follow-up. The outcome was assessed using the Knee Society score, WOMAC and Kaplan–Meier survivorship analysis.

Results

An haematogenous infection occurred in two patients. In three patients, component revision was needed: two because of an infection and one because of a mechanical failure. After a mean follow-up of 9.6 years (2–20), 94% of the patients rated their result as either excellent or good. At time of follow-up, the Knee Society Score averaged 73.3 points (range, 29–100) and showed a significant gain (p < 0.001) compared to preoperative. Flexion contracture could be reduced significantly (p < 0.001) from 18.1° preoperatively to 8.4° at follow-up, whereas flexion remained unchanged. When infection or any component replacement was set as endpoints, the 10 years prosthetic survival was 90 and 86%, respectively.

Conclusion

Total knee arthroplasty in haemophilic patients is a reliable treatment that results in pain relief and functional improvement with a low risk of postoperative infection. However, neither the postoperative infection rate nor the functional result does reach the same level as in a population not affected by haemophilia.

Level of evidence

IV.

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References

  1. Aglietti P, Buzzi R, De Felice R, Giron F (1999) The insall-burstein total knee replacement in osteoarthritis: a 10-year minimum follow-up. J Arthroplast 14(5):560–565

    Article  CAS  Google Scholar 

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

    CAS  Google Scholar 

  3. Bae DK, Yoon KH, Kim HS, Song SJ (2005) Total knee arthroplasty in hemophilic arthropathy of the knee. J Arthroplast 20(5):664–668

    Article  Google Scholar 

  4. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840

    PubMed  CAS  Google Scholar 

  5. Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D (1997) Total knee replacement in young, active patients. long-term follow-up and functional outcome. J Bone Jt Surg Am 79(4):575–582

    CAS  Google Scholar 

  6. Fischer K, van der Bom JG, Mauser-Bunschoten EP, Roosendaal G, Prejs R, de Kleijn P, Grobbee DE, van den Berg M (2002) The effects of postponing prophylactic treatment on long-term outcome in patients with severe hemophilia. Blood 99(7):2337–2341

    Article  PubMed  CAS  Google Scholar 

  7. Goddard NJ, Mann HA, Lee CA (2010) Total knee replacement in patients with end-stage haemophilic arthropathy: 25-year results. J Bone Jt Surg Br 92(8):1085–1089

    Article  CAS  Google Scholar 

  8. 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 Jt Surg Br 83(7):1050–1054

    Article  CAS  Google Scholar 

  9. 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 

  10. Jamsen E, Huhtala H, Puolakka T, Moilanen T (2009) Risk factors for infection after knee arthroplasty. a register-based analysis of 43,149 cases. J Bone Jt Surg Am 91(1):38–47

    Article  Google Scholar 

  11. Khaw FM, Kirk LM, Gregg PJ (2001) Survival analysis of cemented Press-Fit Condylar total knee arthroplasty. J Arthroplast 16(2):161–167

    Article  CAS  Google Scholar 

  12. 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 

  13. Legroux-Gerot I, Strouk G, Parquet A, Goodemand J, Gougeon F, Duquesnoy B (2003) Total knee arthroplasty in hemophilic arthropathy. Jt Bone Spine 70(1):22–32

    Article  Google Scholar 

  14. Lobet S, Pendeville E, Dalzell R, Defalque A, Lambert C, Pothen D, Hermans C (2008) The role of physiotherapy after total knee arthroplasty in patients with haemophilia. Haemophilia 14(5):989–998

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  16. Peersman G, Laskin R, Davis J, Peterson M (2001) Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 392:15–23

    Article  PubMed  Google Scholar 

  17. Pettersson H, Ahlberg A, Nilsson IM (1980) A radiologic classification of hemophilic arthropathy. Clin Orthop Relat Res 149:153–159

    PubMed  Google Scholar 

  18. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466:1710–1715

    Article  PubMed  Google Scholar 

  19. 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 

  20. Ritter MA, Meneghini RM (2010) Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. J Arthroplast 25(4):507–513

    Article  Google Scholar 

  21. Rodriguez-Merchan EC (2002) Total knee arthroplasty in patients with haemophilia who are HIV-positive. J Bone Jt Surg Br 84(2):170–172

    Article  Google Scholar 

  22. Rodriguez-Merchan EC (2007) Total knee replacement in haemophilic arthropathy. J Bone Joint Surg Br 89(2):186–188

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  24. van den Berg HM, Fischer K (2003) Prophylaxis for severe hemophilia: experience from Europe and the United States. Semin Thromb Hemost 29(1):49–54

    Article  PubMed  Google Scholar 

  25. White GC, 2nd, Rosendaal F, Aledort LM, Lusher JM, Rothschild C, Ingerslev J (2001) Definitions in hemophilia. Recommendation of the scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the International Society on Thrombosis and Haemostasis. Thromb Haemost 85 (3):560

    Google Scholar 

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Acknowledgment

The authors acknowledge the work of M. Rodriquez and J. Romero (former orthopaedic knee surgeons, Department of Orthopaedics, University of Zurich, Balgrist) and of E.O. Meili (former haematologist, Department of Haematology, University Hospital of Zurich) they contributed towards the early patients of this series.

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Authors and Affiliations

  1. Division of Knee Surgery, Department of Orthopaedics, University of Zurich Balgrist, Forchstrasse 340, 8008, Zürich, Switzerland

    Patrick O. Zingg, Sandro F. Fucentese & Peter P. Koch

  2. Raemistrasse 100, 8091, Zurich, Switzerland

    Willy Lutz, Brigit Brand & Nadja Mamisch

  3. Department of Haematology, University Hospital of Zurich, Zurich, Switzerland

    Willy Lutz & Brigit Brand

  4. Department of Radiocopy, University Hospital of Zurich, Zurich, Switzerland

    Nadja Mamisch

Authors
  1. Patrick O. Zingg
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  2. Sandro F. Fucentese
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  3. Willy Lutz
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  4. Brigit Brand
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  5. Nadja Mamisch
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  6. Peter P. Koch
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Corresponding author

Correspondence to Peter P. Koch.

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Zingg, P.O., Fucentese, S.F., Lutz, W. et al. Haemophilic knee arthropathy: long-term outcome after total knee replacement. Knee Surg Sports Traumatol Arthrosc 20, 2465–2470 (2012). https://doi.org/10.1007/s00167-012-1896-7

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  • DOI: https://doi.org/10.1007/s00167-012-1896-7

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