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Haemophilic arthropathy: Long-term outcomes in 107 primary total knee arthroplasties

2013; Elsevier BV; Volume: 21; Issue: 1 Linguagem: Inglês

10.1016/j.knee.2013.09.010

1873-5800

Marianne Westberg, A Paus, Pål André Holme, Geir E. Tjønnfjord,

Orthopedic Infections and Treatments

Arthropathy of the knee is a frequent complication in patients with severe bleeding disorders leading to considerable pain and disability. Total knee arthroplasty (TKA) provides marked pain relief. However, a modest functional outcome and a high number of complications due to prosthetic infection and loosening are reported. Data on long-term outcomes are scarce, and most case series include few patients. We have studied clinical outcomes and complications of TKAs with special emphasis on prosthetic survival and periprosthetic infection.A consecutive series of 107 TKAs in 74 patients with haemophilic arthropathy were retrospectively reviewed. Follow-up was mean 11.2 years (range 0.8-33.1 years).Five- and 10-year survival rates, with component removal for any reason as the end point, were 92% and 88%, respectively. Twenty-eight TKAs were removed after median 10 years (range 0.8-28 years). The most common cause of failure was aseptic loosening (14 knees) and periprosthetic infection (seven knees). The overall infection rate was 6.5%. The mean postoperative drop in haemoglobin levels was 4.3 g/dL (range 0.5-9.4) with a significant difference between haemophilia A patients with and without inhibitor (6.3 g/dL (range 3.6-9.4) versus 3.7 g/dL (range 0.5-8.1) (p<0.001). A painless knee was reported in 93% of the TKAs at the latest follow-up.The medium and long-term results of primary TKA in a large haemophilic population show good prosthetic survival at five and 10 years with an excellent relief of pain. Periprosthetic infection is still a major concern compared to the non-haemophilic population.Level IV.