Factors influencing the long-term outcome of primary total knee replacement in haemophiliacs: A review of 116 procedures at a single institution

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Abstract

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.

Original languageEnglish
Pages (from-to)227-234
Number of pages8
JournalBritish Journal of Haematology
Volume145
Issue number2
DOIs
Publication statusPublished - Apr 2009

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Knee Replacement Arthroplasties
Prostheses and Implants
Knee
Special Hospital
Social Adjustment
Joint Diseases
Contracture
Hemostatics
Articular Range of Motion
Infection
Orthopedics
HIV
Pain
Survival
Surgeons
Therapeutics

Keywords

  • Haemophilia
  • Infection
  • Inhibitors
  • Surgery
  • Total knee replacement

ASJC Scopus subject areas

  • Hematology

Cite this

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abstract = "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.",
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