Perioperative management and short-term clinical evaluation in hemophilia arthritis patients following total knee arthroplasty: a retrospective study / 中华骨科杂志

ABSTRACT

Objective To investigate the perioperative management,coagulation factor regulation in total knee arthroplasty (TKA) for hemophilia arthritis and evaluate its short-term clinical efficacy.Methods A retrospective study was performed in hemophilia arthritis patients who had undergone TKA from March,2009 to March,2014.Patients with type A hemophilia received Lyophilized Human Factor Ⅷ,and type B hemophilia patients received Prothrombin Complex.Perioperative accurate dosage of coagulation factor was determined by preliminary test.AORI T1,T2 bone defects were filled with PMMA,and severe contained AORI T3 defects were fixed with impaction allograft and screws,and for non-contained AORI T3 bone defects,structural allografts and stem extension may be considered.Knee function was evaluated by HSS score,and imaging change was evaluated by anteroposterior and lateral radiographs of knee at latest follow-up.Results Eight patients (10 knees) were included with a mean age of 38.3±5.0 years,in which 6 were type A,and the other 2 were type B.Preoperative APTT was 63.9±4.0 s,and coagulation factor activity was 2.6％±0.9％.All the patients had flexion deformity with extension of-12.0°±5.9° and flexion of-88.0°± 11.4°.Three patients (3 knees) had valgus deformity with-3.0°±5.4°,and 2 patients (4 knees) had varus deformity with-4.5°±6.0°.All the 8 patients were followed for a mean of 14.3 months.The range of motion was improved with 0°-98.5°±6.7° at latest follow-up,and the postoperative HSS score was 88.3±4.6 compared with 42.3±10.9 preoperatively.Bone-grafting was survival,and no loosening of prosthesis or screws were detected from X-ray at latest follow-up.Conclusion The early results of TKA in Hemophilia arthritis patients are satisfactory.Preoperative preliminary test was helpful to determine the accurate dosage of coagulation factor.A stable high level of coagulation factor was vital to control bone-cement bleeding and make prosthesis stable.Tibial bone defects involving ＜ 1/3 area and ＜ 1 cm in depth could be filled with PMMA,and impaction allograft and screws could be used to fix severe contained bone defects.For segmental bone defects,except of structural allograft,stem extension was recommended to reduce stress and increase stability.