Comparison of metal on metal versus polyethylene-ceramic bearing in uncemented total hip arthroplasty in patients with haemophilic arthropathy.

PURPOSE: We report the results of a consecutive series of 12 cases with haemophilic hip arthropathy treated with uncemented total hip arthroplasty (THA). Our hypothesis was that THA results in the haemophilic group would be inferior to those in the nonhaemophilic group. METHODS: The clinical histories of 12 consecutive THAs in eight patients (all men) with hereditary bleeding disorders (haemophilia A and B and von Willebrand disease) were reviewed retrospectively. The results were compared with an age- and sex-matched control group without haemophilia, with special emphasis on bearing surfaces (Metasul metal-on-metal; polyethylene-ceramic articulation). RESULTS: The mean follow-up of the control group was 9.7 (range five to 24) years and was similar to the haemophilia group, with 10.4. Survival in the Metasul haemophilic group was 22.2 % after 18 years, which significantly differed from the Metasul control group (100 % after 24 years). Survival of the polyethylene-ceramic haemophilic group was similar to the control group (100 % after seven years in both groups). CONCLUSIONS: The metal-on-metal bearing surface in patients with haemophilia gave inferior results compared with nonhaemophilic patients. The use of metal-on-metal bearings in haemophilia is debatable.

Outcome of total knee arthroplasty in hemophilic arthropathy.

The clinical histories of 45 consecutively performed TKAs in 32 patients with hereditary bleeding disorders were reviewed retrospectively. The mean follow up was 88.7 (range, 24-232) months. The cumulative probability of infection free-survival was 87.8% after 180 months. When removal of component was defined as endpoint, the survival probability was 86.4% after 180 months. In regression analysis no significant independent risk factors for infection or aseptic loosening were identified. The HSS score improved significantly from 45 to 85 points. Hemophilic patients can be considered to be at high risk for prosthetic failure, our study has demonstrated favorable functional results of total knee arthroplasty in hemophilic patients.

No difference in ROM and knee function between mobile and floating platforms in TKA.

PURPOSE: The purpose of this study was to determine whether the floating platforms (FP) were superior to rotating platforms (RP) in computer-navigated total knee arthroplasty (TKA) comparing the range of motion (ROM) as well as clinical and subjective function of the knee. METHODS: This retrospective non-randomized single-centre cohort study includes 255 patients with a primary implanted computer-navigated e.motion™ (Aesculap B. Braun) TKA system, implanted because of clinical and radiological verified gonarthrosis. In 129 patients, the FP platform was implanted, and in 126 patients, the RP platform. As statistical procedures for differences between inlay type RP/FP in ROM and Knee Society Score (KSS) after 3- and 24-month follow-up, an analysis of covariance (with risk factors gender, age, BMI, preoperative ROM and preoperative KSS) was performed. RESULTS: Although preoperative ROM and knee society function score (KSS part II) were significantly higher in the FP group before surgery, there was no significant difference between RP and FP in ROM and KSS at 3- and 24-month follow-up. CONCLUSION: The FP platform design did not have an advantage in ROM as well as in clinical and subjective knee function compared with the RP platform in computer-navigated TKA neither in early follow-up examinations at 3 months postoperatively nor at long-time follow-up at 24 months postoperatively.

Surgical treatment of the haemophilic pseudotumour: a single centre experience.

PURPOSE: Haemophilic pseudotumour was defined by Fernandez de Valderrama and Matthews as a progressive cystic swelling involving muscle, produced by recurrent haemorrhage into muscles adjacent to the bone. The pseudotumour mainly occurs in the long bones and the pelvis. The treatment of the haemophilic pseudotumour poses a challenge, and extensive clinical experience is essential to appropriately address this serious complication in patients with haemophilia. Consequently, the aim of this study is to present our own clinical experience and treatment results of the haemophilic pseudotumour. METHODS: We retrospectively reviewed the records of 87 patients with bleeding disorders treated between 1967 and 2011 for musculoskeletal complications of congenital bleeding disorders. We identified six patients with a haemophilic pseudotumour who were treated at our department. RESULTS: The mean age at surgery was 45.9 (range, 40-61) years. The iliac bone was affected in three patients (one right, two left), the right tibia (distal diaphysis) in one, the right thigh in two and the right ulna (proximal part) in one patient. One patient had two pseudotumours. The perioperative course was easily controllable with adequate factor VIII substitution. At the latest follow-up after 8.4 (range, 4-24) years, normal healing with no recurrence was observed. CONCLUSIONS: The haemophilic pseudotumour is a rare but severe complication of hereditary bleeding disorders. In the international literature the resection and postoperative course are described as challenging and difficult, requiring detailed preoperative planning. It is advisable to perform such operations in specialised centres with close co-operation between surgeons and haematologists.