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Chhetri P, Soon C, Shakya AR, Jung Khatri K. TKR in Hemophilic Arthropathy: A Combination of Special Surgical Considerations and Novel Nonacog Beta Pegol: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00017. [PMID: 39058793 DOI: 10.2106/jbjs.cc.24.00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
CASE A 29-year-old man with hemophilia B presented with advanced arthropathy of the right knee, resulting in poor knee functional scores and difficulties in his livelihood. The patient underwent total knee replacement while receiving nonacog beta pegol factor IX by a multidisciplinary approach. CONCLUSION Hemophilias commonly result in end-stage hemophilic arthropathy of the joints at a young age that may warrant joint replacement surgeries. This case report illustrates the surgical protocol of total knee arthroplasty in a patient who received a long-acting factor IX preparation.
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Hoffer AJ, Lin EA, Kalani MA, Lyons MK, Richardson M. Excision of Intra-articular Knee Heterotopic Ossification Using a 70° Arthroscope. Case Rep Orthop 2024; 2024:9998388. [PMID: 38962285 PMCID: PMC11221981 DOI: 10.1155/2024/9998388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/22/2024] [Accepted: 05/16/2024] [Indexed: 07/05/2024] Open
Abstract
Heterotopic ossification is ectopic lamellar bone formation within soft tissue and can result in significant functional limitations. There are multiple underlying etiologies of HO including musculoskeletal trauma and traumatic brain injury. Intra-articular HO of the knee is rare and is typically located within the cruciate ligaments. We report a case of a 24-year-old female who presented with worsening right knee pain and limited knee extension two and a half years after a motor vehicle crash with multiple lower extremity fractures. Physical examination of the knee revealed anterior pain, limited extension, and a palpable infrapatellar prominence. Imaging showed a retropatellar tendon, intra-articular excrescence of bone proximal to the anterior tibial plateau. Diagnostic arthroscopy with a 70° arthroscope identified HO at the proximal anterior tibial plateau, which was excised with a high-speed burr under direct visualization. At the three-month follow-up, the patient remained asymptomatic and returned to sport. Retropatellar tendon, intra-articular anterior knee HO is a rare but debilitating clinical entity that can be successfully and safely managed with excision under direct visualization using a 70° arthroscope.
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Affiliation(s)
- Alexander J. Hoffer
- Department of Orthopedic SurgeryMayo Clinic, 5881 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Eugenia A. Lin
- Department of Orthopedic SurgeryMayo Clinic, 5881 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Maziyar A. Kalani
- Department of Orthopedic SurgeryMayo Clinic, 5881 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Mark K. Lyons
- Department of Orthopedic SurgeryMayo Clinic, 5881 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Meghan Richardson
- Department of Orthopedic SurgeryMayo Clinic, 5881 E. Mayo Blvd., Phoenix, AZ 85054, USA
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Gong Y, Su H, Jin Z, Zhou H, Chen L, Chen R, Tang Y, Lu Y, Chen J, Chen G, Tong P. Bleeder's Femur: The Proximal Femoral Morphology in Hemophilic Patients Who Underwent Total Hip Arthroplasty. Orthop Surg 2024; 16:718-723. [PMID: 38180272 PMCID: PMC10925505 DOI: 10.1111/os.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Patients with hemophilia (PWH) constantly suffer hemarthrosis, which leads to deformity of the hip joint. Therefore, PWH who are going to receive total hip arthroplasty (THA) should be exclusively treated before the surgery with careful measurement of their proximal femur. Hence, we conducted a retrospective study to explore the anatomical parameters of and differences in the proximal femur in hemophilic patients who underwent THA. METHODS The retrospective study comprised data of adult patients who received total hip arthroplasty from 2020 to 2022 in the research center. Patients having a diagnosis of hemophilic arthritis and received THA were included in experimental group, and patients with hip arthritis or femoral head necrosis were taken as control group. Parameters including femoral offset, neck-shaft angle (NSA), medullary cavity of 20 mm above mid-lesser trochanter level (T+20), mid-lesser trochanter level (T), and 20 mm blow it (T-20), and canal flare index (CFI), femoral cortical index (FCI) were measured on X-ray and CT images with PACS by two independent doctors. Data was analyzed by SPSS 20. Kolmogorov-Smirnov test was used to test data normality. Student's t-test was performed between PWH and control group. p < 0.05 was considered statistically significant. RESULTS Among the 94 hips, 39 (41.5%) were included in group hemophilia and 55(58.5%) in control group. The mean age of the patients was 49.36 ± 12.92 years. All cases were male patients. Data demonstrated significantly smaller femoral cortical index (FCI), femoral offset, medullary cavity of 20 mm above mid-lesser trochanter level, mid-lesser trochanter level, and 20 mm below it, and neck-shaft angle (NSA) was obviously larger in PWH than control group (p < 0.05). No significant difference was found in canal flare index (CFI). CONCLUSION Hemophilic patients undergoing THA were prone to longer and thinner proximal femur. Preoperative morphological analysis of femur is recommended.
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Affiliation(s)
- Yichen Gong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Hai Su
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Haojin Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Ruinan Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Yi Tang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Yichen Lu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Jiali Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Guoqian Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
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Fu H, Peacock C, Wang C, Kader D, Clement N, Asopa V, Sochart D. The effect of HIV prevalence, CD4 counts and disease severity on the outcome of total knee arthroplasty for haemophilic arthropathy: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3235-3254. [PMID: 37212914 DOI: 10.1007/s00590-023-03586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE End-stage knee arthropathy is a recognised complication of haemophilia. It is often treated by total knee arthroplasty (TKA), which is more technically challenging in patients with haemophilia (PwH). It remains unclear what factors may predict implant survivorship and deep infection rate. Therefore, we systematically review the evidence regarding TKA survivorship and infection in PwH, compared to the general population, and determine the important factors influencing survivorship, particularly HIV and CD4 + count. METHODS A systematic literature review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting Kaplan-Meier survivorship for TKA in PwH (PROSPERO CRD42021284644). Meta-analysis was performed for survivorship, and the results compared to < 55-year-olds from the National Joint Registry (NJR). Meta-regression was performed to determine the impact of relevant variables on 10-year survivorship, with a sub-analysis focusing on HIV. RESULTS Twenty-one studies were reviewed, totalling 1338 TKAs (average age 39 years). Implant survivorship for PwH at 5, 10, and 15 years was 94%, 86%, and 76% respectively. NJR-reported survivorship for males < 55 years was 94%, 90%, and 86%. Survivorship improved over time (1973-2018), and correlated inversely with HIV prevalence. Infection rate was 5%, compared to 0.5-1% in the NJR. Infection was not significantly increased with higher HIV prevalence, and CD4 + count had no effect. Complications were inconsistently reported. CONCLUSION Survivorship was similar at 5 years but declined thereafter, and infection rate was six-fold higher. HIV was related to worse survivorship, but not increased infection. Meta-analysis was limited by inconsistent reporting, and standardised reporting is required in future studies.
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Affiliation(s)
- Howell Fu
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK.
| | - Christian Peacock
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
| | - Chao Wang
- Faculty of Health, Science, Social Care and Education, Kingston University, Kingston Hill, Kingston upon Thames, Surrey, KT2 7LB, UK
| | - Deiary Kader
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
| | - Nick Clement
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Cres, Old Dalkeith Rd, Edinburgh, EH16 4SA, UK
| | - Vipin Asopa
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
| | - David Sochart
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
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Rodriguez-Merchan EC. Hemophilic arthropathy: how to diagnose subclinical bleeding early and how to orthopedically treat a damaged joint. Expert Rev Hematol 2023; 16:651-658. [PMID: 37392151 DOI: 10.1080/17474086.2023.2232547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION It is important to know the current status of hemophilic arthropathy diagnoses, treatments, complications, and outcomes in developed countries. AREAS COVERED A bibliographic search in PubMed for articles published from 1 January 2019 through 12 June 2023 was performed. EXPERT OPINION In developed countries with specialized hemophilia treatment centers, primary hematological prophylaxis (started before the age of 2 years and after no more than one joint bleed) has almost completely eliminated the joint-related problems of the disease. The ideal goal of zero hemarthroses can be achieved only with intense and well-dosed prophylaxis: intravenous infusion of coagulation factor - standard half-life or extended half-life; periodic or subcutaneous injections of nonfactor products (emicizumab or fitusiran). However, hemophilic arthropathy continues to occur due to subclinical joint hemorrhages. In one study, 16% of the joints without reported hemarthroses showed signs of previous subclinical bleeding (hemosiderin deposits with/without synovial hypertrophy on magnetic resonance imaging were deemed signs of previous subclinical bleeding), rendering evidence for subclinical bleeding in people with severe hemophilia with lifelong prophylaxis treatment. Subclinical joint hemorrhages can be averted only by employing accurate and tailored prophylaxis.
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Rodriguez-Merchan EC. Synovitis in hemophilia: preventing, detecting, and treating joint bleeds. Expert Rev Hematol 2023:1-10. [PMID: 37119182 DOI: 10.1080/17474086.2023.2209717] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Most bleeding events in individuals with hemophilia occur within the ankle, knee, and elbow joints. Should the bleeding persist, the synovial membrane starts to hypertrophy and a vicious cycle of chronic hemophilic synovitis (CHS) occurs, leading to joint destruction. AREAS COVERED This article covers the prompt diagnosis of CHS by point-of-care ultrasonography (POC-US) and its treatment by means of several types of synovectomy. EXPERT OPINION It is essential to prevent, detect and treat hemophilic synovitis, because it indicates that the joint has bled and is at risk of bleeding further. Prophylaxis with standard half life (SHL) factor VIII (FVIII) concentrate is the standard of care for individuals with severe hemophilia A and can also be considered for selected patients with moderate disease. Several years of real-world experience with extended half life (EHL) FVIII, emicizumab, and other drugs in development will be needed to ascertain their final effect on bleeding and its complications. We must look for synovitis in individuals declaring joint pain and in asymptomatic patients, and POC-US is the most reasonable imaging instrument with which to carry out periodic joint screening. Radiosynovectomy, chemical synovectomy, and arthroscopic synovectomy markedly reduce bleeding events.
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Yin DL, Lin JM, Li YH, Chen P, Zeng MD. Short-term outcome of total knee replacement in a patient with hemophilia: A case report and review of literature. World J Clin Cases 2023; 11:2788-2795. [PMID: 37214564 PMCID: PMC10198112 DOI: 10.12998/wjcc.v11.i12.2788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Hemophilia A is a rare inherited bleeding disorder caused by mutations in the factor VIII gene. This clotting factor plays an intrinsic role in the blood coagulation pathway. Patients with hemophilia may develop orthopedic manifestations such as hemarthrosis, but multiple malunion of fractures over the knee is rare and difficult to treat.
CASE SUMMARY We report a patient with hemophilia A who developed severe knee osteoarthritis along with fracture malunion and nonunion. Total knee replacement was performed using a custom-made modular hinged knee prosthesis (cemented) equipped with extended distal and proximal stems. At 3 years’ follow-up, the patient exhibited excellent clinical function and remained satisfied with the surgical outcome. Surgical intervention was accompanied by rigorous coagulation factor replacement.
CONCLUSION This case highlights various unique scenarios specific to individuals with hemophilia and fracture deformity.
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Affiliation(s)
- De-Long Yin
- Department of Orthopedic, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Jia-Min Lin
- Department of Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yuan-Hui Li
- Department of Orthopedic, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Peng Chen
- Department of Orthopedic, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
- Department of Orthopedic, Yichang Chinese Medicine Hospital, Yichang 443003, Hubei Province, China
| | - Mian-Dong Zeng
- Department of Orthopedic, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
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Khan MJ, Asif N, Siddiqui YS, Aziz MH, Raza A, Alam N. Haemophilic arthropathy of the knee: a surgeon's nightmare. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2023; 13:89-93. [PMID: 37215510 PMCID: PMC10195220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/22/2023] [Indexed: 05/24/2023]
Abstract
Surgical management of knee synovitis secondary to mild haemophilia, without any significant previous medical history and an adverse family history of haematological disorders, is arduous. Due to its rare occurrence, the diagnosis is often delayed or sometimes missed, leading to the grave and often lethal consequences in intraoperative and postoperative periods. Hardly isolated knee arthropathy due to mild haemophilia has been reported in the available literature. In this report, we present the management of a case of a 16-year-old male with isolated knee synovitis with undiagnosed mild haemophilia, who came to us with the first episode of knee bleeding. We elucidate the signs and symptoms, investigations, surgical management, and difficulties faced, especially during the postoperative period. This case report is presented to enhance awareness of the existence of this disorder and its management to prevent postoperative complications.
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Affiliation(s)
| | - Naiyer Asif
- Department of Orthopaedic Surgery, JNMCH, AMUAligarh, Uttar Pradesh, India
| | | | - Mohd Hadi Aziz
- Department of Orthopaedic Surgery, JNMCH, AMUAligarh, Uttar Pradesh, India
| | - Ariz Raza
- Department of Orthopaedic Surgery, Hamdard Institute of Medical Sciences & Research (HIMSR)New Delhi, India
| | - Noor Alam
- Department of Orthopaedic Surgery, JNMCH, AMUAligarh, Uttar Pradesh, India
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He BJ, Mao Q, Li J, Lv SJ, Tong P, Jin HT. Bilateral synchronous total hip arthroplasty for end-stage arthropathy in hemophilia A patients: A retrospective study. Medicine (Baltimore) 2022; 101:e29667. [PMID: 35801796 PMCID: PMC9259152 DOI: 10.1097/md.0000000000029667] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Total hip arthroplasty (THA) has been an effective tool of advanced hemophiliac hip arthritis. There are only limited data of bilateral synchronous THA for end-stage arthropathy in hemophilia A patients. The aim of this retrospective study was to analyze clinical outcome and complication rate of bilateral THA for hemophilia A patients with end-stage arthropathy of hip and review the operative strategy. From August 2012 to July 2016, 48 hips of 24 patients with hemophilia A patients underwent THA by a single experienced chief orthopedic surgeon. Clinical and radiological evaluations were included of operation time, blood loss, the quantity of blood transfusion, clotting factor consumption, duration of hospitalization, modified Harris hip score, complication rate, and radiographic assessment. All the 24 patients successfully completed the operation, followed up for 5 to 8 years, and the mean time was 6.5 years. The average operation time was 140 minutes (range, 120-180 minutes). The average total blood loss was 225 mL (range, 150-400 mL). The mean red blood cell transfusion amount was 2.4 U (range, 0-6 U). the mean hospitalization time was 24 days (range, 16-46 days). The mean amount of clotting factor VIII used in the perioperative period for management of hemophilia A was 30,600 U (range, 18,000-52,000 U). Average modified Harris hip score increased from 46.6 (range 28-70) points preoperatively to 90.2 (range 75-98) points at final follow-up, complications were few. With excellent operative techniques and hematological management, bilateral synchronous THA for end-stage arthropathy in hemophilia A patients can provide satisfactory outcomes.
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Affiliation(s)
- Bang Jian He
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Traditional Chinese Medicine University, Hangzhou, China
| | - Qiang Mao
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Traditional Chinese Medicine University, Hangzhou, China
| | - Ju Li
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Traditional Chinese Medicine University, Hangzhou, China
| | - Shuai Jie Lv
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Traditional Chinese Medicine University, Hangzhou, China
| | - Peijian Tong
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Traditional Chinese Medicine University, Hangzhou, China
| | - Hong Ting Jin
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Traditional Chinese Medicine University, Hangzhou, China
- * Correspondence: Hong Ting Jing, Department of Orthopedic Surgery, the First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54, Youdian Road, Hangzhou 310006, China (e-mail: )
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Gillinov SM, Burroughs PJ, Moore HG, Rubin LE, Frumberg DB, Grauer JN. Total Hip Arthroplasty in Patients With Classic Hemophilia: A Matched Comparison of 90-Day Outcomes and 5-Year Implant Survival. J Arthroplasty 2022; 37:1333-1337. [PMID: 35257821 PMCID: PMC9177736 DOI: 10.1016/j.arth.2022.02.107] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with classic hemophilia can develop joint hemarthroses, degenerative changes, and eventually require total hip arthroplasty (THA). Little data exist concerning THA outcomes in this population, and evidence-based guidelines specifically addressing venous thromboembolism (VTE) prophylaxis in this population are lacking. METHODS A retrospective study was conducted using the 2010-2020 PearlDiver MHip database. Patients undergoing primary THA were identified, and those with classic hemophilia were matched 1:10 with non-hemophilia patients based on age, gender, and Elixhauser Comorbidity Index. Ninety-day serious adverse events, minor adverse events, and any adverse events were compared with multivariate analysis. Reoperation at 5 years was assessed using Kaplan-Meier analysis. RESULTS Five hundred eighteen classic hemophilia THA patients were matched 1:10 with 5,193 non-hemophilia patients. On multivariate analysis, those with classic hemophilia had greater odds of aggregated any adverse events (odds ratio [OR] 1.76), serious adverse events (OR 2.30), and minor adverse events (OR 1.52) (P < .001 for each). Patients with classic hemophilia had greater odds of bleeding issues (transfusion, OR 1.98; hematoma, OR 4.23; P < .001 for both), VTE (deep vein thrombosis, OR 2.67; pulmonary embolism, OR 4.01; P < .001 for both), and acute kidney injury (OR 1.63; P = .03). Five-year implant survival was lower in hemophilia patients (91.9%) relative to matched controls (95.3%; P = .009). CONCLUSION Hemophilia patients undergoing THA had elevated risks of both 90-day bleeding complications (transfusion and hematoma) and VTE (deep vein thrombosis and pulmonary embolism) relative to matched controls. These findings emphasize the need to balance factor replacement and VTE prophylaxis. Although the 5-year implant survival was lower in hemophilia patients, this represented a difference of 3.4% at 5 years, suggesting that THA remains effective in this cohort.
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Affiliation(s)
| | | | | | - Lee E. Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - David B. Frumberg
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Rodriguez-Merchan EC. Hemophilic arthropathy: a teaching approach devoted to hemophilia treaters in under-development countries. Expert Rev Hematol 2021; 14:887-896. [PMID: 34482789 DOI: 10.1080/17474086.2021.1977118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Arthropathy is the characteristic injury of hemophilia, primarily occurring in the elbows, knees, and ankles. The aim of this review is a teaching approach devoted to hemophilia treaters in under-development countries. AREAS COVERED Current major challenges include the absence of the following therapeutic tools for all people with hemophilia (PWH) worldwide: hematological prophylaxis; well-coordinated multidisciplinary teams in specialized centers; joint aspiration of acute hemarthrosis; point-of-care ultrasonography (POC-US); exercise; treatment of synovitis by means of radiosynovectomy; treatment of mild hemophilic arthropathy with analgesics, anti-inflammatory agents, and rehabilitation medicine; intra-articular injections of corticosteroids, hyaluronic acid, platelet-rich plasma, and mesenchymal stem cells; and treatment of severe hemophilic arthropathy by surgical treatment. The future scenario in under-development countries should include all the aforementioned treatment tools plus the possibility of performing total joint arthroplasty in PWH with inhibitors; concomitant use of bypassing agents with emicizumab for PWH with inhibitors undergoing orthopedic surgery; and telemedicine. EXPERT OPINION Primary hematological prophylaxis is now the gold standard for the management of hemophilia. Acute hemarthrosis needs intense hematological management and articular aspiration; the articular situation should be scrutinized by POC-US. Synovitis can be controlled by radiosynovectomy. In cases of severe articular degeneration, surgical procedures might be required.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain.,Osteoarticular Surgery Research, La Paz University Hospital Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Bonanad S, Núñez R, Poveda JL, Kurnik K, Goldmann G, Andreozzi V, Vandewalle B, Santos S. Matching-Adjusted Indirect Comparison of Efficacy and Consumption of rVIII-SingleChain Versus Two Recombinant FVIII Products Used for Prophylactic Treatment of Adults/Adolescents with Severe Haemophilia A. Adv Ther 2021; 38:4872-4884. [PMID: 34368918 PMCID: PMC8408075 DOI: 10.1007/s12325-021-01853-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/30/2021] [Indexed: 12/03/2022]
Abstract
Introduction Given the relatively small number of patients with haemophilia A, head-to-head comparisons between recombinant FVIII (rFVIII) products are difficult to conduct. This study compared the efficacy and consumption of rVIII-SingleChain (lonoctocog alfa, AFSTYLA®) with rAHF-PFM (octocog alfa, Advate®) and rFVIIIFc (efmoroctocog alfa, Elocta®), for the prophylaxis and treatment of bleeding episodes in previously treated adolescents/adults with severe haemophilia A, through a matching-adjusted indirect comparison (MAIC). Methods A systematic literature review identified published clinical trials for rAHF-PFM and rFVIIIFc. Individual patient data for rVIII-SingleChain were used to match baseline patient characteristics to those from published trials, using an approach similar to propensity score weighting. After matching, annualized bleeding rates (ABR), percentage of patients with zero bleeds, and rFVIII consumption were compared across trial populations. Results Published data were identified from two rAHF-PFM trials and one rFVIIIFc trial. rVIII-SingleChain had similar ABR (risk ratio [RR]: 0.74 [0.16; 3.48]; RR: 1.18 [0.85; 1.65]) and percentage of patients with zero bleeds (odds ratio [OR]: 1.34 [0.56; 3.22]; OR: 0.78 [0.47; 1.31]) versus rAHF-PFM and rFVIIIFc, respectively. Annual rVIII-SingleChain consumption was significantly lower than rAHF-PFM (mean difference: − 1507.66 IU/kg/year [− 2011.71; − 1003.61]) and equivalent to rFVIIIFc (RR: 0.96 [0.62; 1.49]). Conclusion Although limited to published information for comparator trials, these results suggest that with an annualized rFVIII consumption comparable to rFVIIIFc, but significantly lower than rAHF-PFM, routine prophylaxis with rVIII-SingleChain is able to maintain a similar ABR and percentage of patients with zero bleeds, attesting to the long-acting nature of rVIII-SingleChain. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01853-0. It is difficult to directly compare different recombinant FVIII products in head-to-head studies because there are few patients with haemophilia A. This study aimed to indirectly compare the efficacy and consumption of different recombinant FVIII products in the prophylactic treatment of haemophilia A using published clinical data. A proven method for performing indirect comparisons of products is referred to as a matching-adjusted indirect comparison. Using this approach, we were able to compare rVIII-SingleChain with two other recombinant FVIII products (rAHF-PFM and rFVIIIFc). Our results suggest that annual FVIII consumption with rVIII-SingleChain is comparable to rFVIIIFc, but is significantly lower than rAHF-PFM, while maintaining a similar bleeding rate. These results highlight the long-acting nature of the product.
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Hotea I, Brinza M, Blag C, Zimta AA, Dirzu N, Burzo C, Rus I, Apostu D, Benea H, Marian M, Mester A, Pasca S, Iluta S, Teodorescu P, Jitaru C, Zdrenghea M, Bojan A, Torok-Vistai T, Niculescu R, Tarniceriu C, Dima D, Truica C, Serban M, Tomuleasa C, Coriu D. Current therapeutic approaches in the management of hemophilia-a consensus view by the Romanian Society of Hematology. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1091. [PMID: 34423003 PMCID: PMC8339806 DOI: 10.21037/atm-21-747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 12/28/2022]
Abstract
Hemophilia A (HA) and hemophilia B (HB) are rare disorders, being caused by the total lack or under-expression of two factors from the coagulation cascade coded by genes of the X chromosome. Thus, in hemophilic patients, the blood does not clot properly. This results in spontaneous bleeding episodes after an injury or surgical intervention. A patient-centered regimen is considered optimal. Age, pharmacokinetics, bleeding phenotype, joint status, adherence, physical activity, personal goals are all factors that should be considered when individualizing therapy. In the past 10 years, many innovations in the diagnostic and treatment options were presented as being either approved or in development, thus helping clinicians to improve the standard-of-care for patients with hemophilia. Recombinant factors still remain the standard of care in hemophilia, however they pose a challenge to treatment adherence because they have short half-life, which where the extended half-life (EHL) factors come with the solution, increasing the half-life to 96 hours. Gene therapies have a promising future with proven beneficial effects in clinical trials. We present and critically analyze in the current manuscript the pros and cons of all the major discoveries in the diagnosis and treatment of HA and HB, as well as identify key areas of hemophilia research where improvements are needed.
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Affiliation(s)
- Ionut Hotea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Melen Brinza
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Blag
- Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Emergency Clinical Children's Hospital, Cluj Napoca, Romania
| | - Alina-Andreea Zimta
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Noemi Dirzu
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Corina Burzo
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Ioana Rus
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dragos Apostu
- Department of Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Orthopedics, Emergency Clinical County Hospital, Cluj Napoca, Romania
| | - Horea Benea
- Department of Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Orthopedics, Emergency Clinical County Hospital, Cluj Napoca, Romania
| | - Mirela Marian
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Alexandru Mester
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Sabina Iluta
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ciprian Jitaru
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Mihnea Zdrenghea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Anca Bojan
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Tunde Torok-Vistai
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Radu Niculescu
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristina Tarniceriu
- Department of Anatomy, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Hematology, St. Spiridon County Clinical Emergency Hospital, Iasi, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Cristina Truica
- Department of Hematology, Constantin Opris Emergency Hospital, Baia Mare, Romania
| | - Margit Serban
- Department of Hematology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.,European Haemophilia Treatment Center, Timisoara, Romania
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Daniel Coriu
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Badulescu OV, Sirbu PD, Ungureanu C, Pȋnzariu A, Cojocaru E, Filip N, Bararu-Bojan I, Vladeanu M, Ciocoiu M. Orthopedic surgery in hemophilic patients with musculoskeletal disorders: A systematic review. Exp Ther Med 2021; 22:995. [PMID: 34345277 DOI: 10.3892/etm.2021.10427] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022] Open
Abstract
Hemophilia is a hereditary coagulopathy caused by factor VIII (hemophilia type A) or by coagulation factor IX (hemophilia type B) dysfunction, characterized by an increased bleeding predisposition, which is either spontaneous or secondary to minimal trauma. Currently, hemophilia may also be considered an 'orthopedic' condition, due to the fact that it affects the musculoskeletal system of most hemophilic patients. In recent years, constant prophylaxis using coagulation factors has led to a significant improvement in the hemophilic patient's quality of life, by reducing both life-threatening hemorrhagic phenomena, as well as the occurrence of chronic complications. Nevertheless, progressive joint bleeding remains unavoidable in this category of patients, and the onset of chronic arthropathy with secondary motor deficiency remains the main complication with an invalidating character. In such cases, orthopedic management is imperative; osteoarticular complications being managed most often with the help of conservative or surgical techniques. The purpose of this review is to provide an overview of modern orthopedic practices which are useful in the management of hemophilic patients suffering from osteoarticular disorders.
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Affiliation(s)
- Oana Viola Badulescu
- Department of Pathophysiology, Morfo-Functional Sciences (II), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Paul Dan Sirbu
- Department of Orthopedics and Traumatology, Surgical Sciences (II), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Carmen Ungureanu
- Department of Pathology, Morfo-Functional Sciences (I), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alin Pȋnzariu
- Department of Physiology, Morfo-Functional Sciences (II), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Pathology, Morfo-Functional Sciences (I), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Nina Filip
- Department of Biochemistry, Morpho-Functional Sciences (II), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iris Bararu-Bojan
- Department of Pathophysiology, Morfo-Functional Sciences (II), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria Vladeanu
- Department of Pathophysiology, Morfo-Functional Sciences (II), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, Morfo-Functional Sciences (II), Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Gao Q, Yao Y, Jing J. Morphological characteristics and clinical significance of the distal femur in patients with hemophilia-related knee arthritis. Medicine (Baltimore) 2020; 99:e22986. [PMID: 33217800 PMCID: PMC7676527 DOI: 10.1097/md.0000000000022986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This retrospective study aimed to define the morphological characteristics of the distal femur in patients with hemophilia-related knee arthritis (HA) and develop precise femoral component installation during total knee arthroplasty (TKA) using a reference axis.Computed tomography (CT) was performed in 75 patients [HA group: 34 patients, 48 knees; osteoarthritis (OA group): 41 patients, 48 knees] during 2017-2019. CT scans were constructed into three-dimensional models. We measured the medial (MPC) and lateral (LPC) posterior condyle widths, lateral anteroposterior (LAP) height, medial anteroposterior (MAP) height, mediolateral epicondyle (ML) width, and depths of the anterior patellar groove (X2) and the intercondylar notch (X4). Also, angles were measured between the posterior condylar line (PCL) and surgical transepicondylar axis (STEA) (PCA angle), anteroposterior axis (APA angle) and STEA (APSA angle), anterior condylar line (ACL) and STEA (ACA angle), and clinical transepicondylar axis (CTEA) and PCL (CTA angle). ML/MAP, ML/LAP, X4/LAP, X2/LAP, and LPC/ML ratios were calculated.There were no significant differences in any angles between the HA and OA groups (P > .05). However, the HA group had a smaller MPC (P < .05) and larger X4 than the OA group (P < .05). ML, ML/LAP, X2, MAP, and LAP showed no significant differences between the 2 groups.ML, ML/LAP, and PCA showed no significant differences between the 2 groups. During TKA in hemophilia-related knee arthritis patients, the femoral component can be installed with PCL as the reference axis, although individual differences should be considered.
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Abstract
Hemophilia A is a rare genetic disorder involving a deficiency of clotting factor VIII. Coagulation factor replacement therapy has prolonged the life expectancy of patients with hemophilia, but recurrent hemarthrosis of major joints is often a common occurrence. Therefore, orthopaedic adult reconstructive surgeons increasingly encounter hemophilic arthropathy in young adults and consider treating with total joint arthroplasty. In this report, the authors describe a patient with hemophilia A and severe knee osteoarthritis, who was subsequently treated with primary total knee arthroplasty. This rare case is an opportunity to explore a variety of unique clinical scenarios specific to patients with hemophilia, including the maintenance of optimal factor VIII levels through clotting factor infusions and prevention of a venous thromboembolic event.
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Abstract
: The role of the orthopedic surgeon is to use invasive and/or surgical methods to treat the musculoskeletal disorders suffered by persons with hemophilia, always within the context of a multidisciplinary team. Muscle hematomas must be diagnosed as early as possible and be subjected to continuous treatment until full resolution, as they are associated with the risk of severe complications (compartment syndromes and pseudotumors). Arthrocentesis (extraction of intra-articular blood) is recommended in cases of acute and profuse hemarthrosis. Synovectomy is mandatory in the case of synovitis. Radiosynovectomy plays a key role as it has been shown to reduce bleeding by 65%. Our department uses Yttrium-90 in knees and Rhenium-186 in elbows and ankles. Radiosynovectomy is our treatment of choice for synovitis whereas arthroscopic synovectomy is resorted to as second-line treatment. Total knee replacement (TKR) has shown itself to be effective for treating severe hemophilic arthropathy, although the infection risk in patients with hemophilia is higher than in patients with osteoarthritis (1-2 vs. 7%).
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Affiliation(s)
- Johnny Mahlangu
- Haematology, University of the Witwatersrand, Johannesburg, South Africa
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19
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Rodriguez-Merchan EC. Risks and patient outcomes of surgical intervention for hemophilic arthropathy. Expert Rev Hematol 2019; 12:325-333. [DOI: 10.1080/17474086.2019.1602035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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20
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Dou Y, Li M, Zhang L, Cheng T, Lei P, Ge Y. Using synovial volume measurement by MRI to evaluate the effect of 32P Radiation synovectomy on hemophilic arthropathy patients. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:187-195. [PMID: 30958324 DOI: 10.3233/xst-180480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the potential of synovial membrane volume measurement by MRI in monitoring the effect of radiation synovectomy on patients of Hemophilic Arthropathy (HA). METHODS We studied 63 diseased joints of 42 HA patients who received hospitalized services at the Hemophilia Diagnosis and Treatment Center of Henan Provincial People's Hospital from May 2011 to January 2015. Unenhanced and enhanced MR scanning of each diseased joint was performed simultaneously. The volumes of synovial membrane of 21 joints from 16 patients before and after being treated with 32P radiation synovectomy (PRS) were measured and compared using image post-processing software and workstation. Two sample matching t test was conducted to analyze the synovial membrane volumes of the same joint measured by unenhanced and enhanced MR, as well as change of MR enhancement ratio after treatments. RESULTS The synovial membrane volumes measured by unenhanced versus enhanced MR scanning showed no statistical significance. Significant reduction (t = 7.831, p < 0.001) of the synovial membrane volume after treatment (2479.45±46.48 mm3 versus 2983.30±42.87 mm3 before treatment) was observed. MR enhancement ratio of synovial membrane decreased after treatment (0.92±0.06 after vs 1.17±0.07 before treatment) with statistical significance. CONCLUSION The synovial membrane volume and MR enhancement ratio can be used to monitor patient response to PRS treatment.
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Affiliation(s)
- Yincong Dou
- Department of Radiology, Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Meixia Li
- Department of Radiology, The first Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Lu Zhang
- Department of Radiology, Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Tianming Cheng
- Department of Radiology, Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Pingchong Lei
- Department of Hematology, Henan Provincial People's Hospital & Hemophilia Diagnosis and Treatment Center of Henan Province, Henan, China
| | - Yinghui Ge
- Department of Radiology, Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, Henan, China
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21
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Lin WY, Wang JD, Tsan YT, Chan WC, Tong KM, Chang ST, Cheng YY. Comparison of Total Joint Replacement Rate Between Patients With Hemophilia A and Patients With Hemophilia B: A Population-Based and Retrospective Cohort Study. Clin Appl Thromb Hemost 2018; 24:163S-170S. [PMID: 30213203 PMCID: PMC6714844 DOI: 10.1177/1076029618794294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Recurrent hemarthrosis in patients with hemophilia (PWH) results in chronic arthropathy
requiring total joint replacement (TJR). This study aimed to compare the difference in TJR
rate between patients with hemophilia A (HA) and hemophilia B (HB). A final total of 935
PWH (782 HA and 153 HB) without inhibitors were collected from the Taiwan’s National
Health Insurance Research Database between 1997 and 2013. Demographics, clinical
characteristics, and TJR rate were compared between the 2 groups. The annual use of
clotting factor concentrate was not different between HA and HB groups (P
= .116). The rate of comorbidities except for 29 PWH having HIV who were all in the HA
group was also not different between the 2 groups. A total of 99 (10.6%) PWH had undergone
142 TJR procedures during the study period. All of them had received on-demand therapy. No
difference was found in the cumulative incidence of TJR between HA and HB
(P = .787). After adjusting for various confounders including age,
pyogenic arthritis, and HIV infection, no increased risk of TJR was found in patients with
HA versus Patients with HB (hazard ratio: 0.92, 95% confidence interval 0.54-1.58). This
finding suggests that the rate of TJR between patients with HA and HB is not significantly
different.
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Affiliation(s)
- Wen-Ya Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Tse Tsan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Cheng Chan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kwok-Man Tong
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
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Abstract
BACKGROUND Rigorous haemostatic control and careful rehabilitation are essential for haemophilic patients undergoing total hip arthroplasty (THA). AIM to examine the current literature regarding THA in patients with haemophilia in order to determine clinical outcomes and complication rates. METHODS We included 11 case reports/series and 9 original articles. There was a total of 206 patients who underwent 226 THAs. FINDINGS The number of patients enrolled in the selected articles varied from 1 in case reports to 34 in the original articles. Gender was documented in 10. Mean age at surgery was 41 years. Mean follow-up was 73 months (standard deviation [SD] 35 months). All but 4 articles specified whether implants were cemented or uncemented, with 95% being uncemented, 3.5% being cemented, and 1.5% being hybrid (uncemented acetabular component, cemented femoral stem). CONCLUSION Controlled hypotensive anaesthesia (to reduce preoperative blood loss), consult with haematologist, precise control of haemostasis status per the guidelines defined by the World Federation joint replacement, can improve the success rate and hip replacement surgery can be performed safely.
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Affiliation(s)
- Ali Parsa
- 1 Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA.,2 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Iran
| | | | - Maryam Mirzaie
- 4 Department of Community Medicine, Mashhad University of Medical Sciences, Iran
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23
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Rodriguez-Merchan EC. Hemophilic arthropathy: current treatment challenges and future prospects. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1508341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Cho YJ, Song SJ, Rhyu KH, Jang TS, Park CH. Clinical and radiologic results after open-wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity. Haemophilia 2018; 24:792-799. [DOI: 10.1111/hae.13566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Y. J. Cho
- Department of Orthopaedic Surgery; College of Medicine; Kyung Hee University; Seoul Korea
| | - S. J. Song
- Department of Orthopaedic Surgery; College of Medicine; Kyung Hee University; Seoul Korea
| | - K. H. Rhyu
- Department of Orthopaedic Surgery; College of Medicine; Kyung Hee University; Seoul Korea
| | - T. S. Jang
- Department of Orthopaedic Surgery; College of Medicine; Kyung Hee University; Seoul Korea
| | - C. H. Park
- Department of Medicine; Graduate School; Kyung Hee University; Seoul Korea
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25
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Rodriguez-Merchan EC. What´s New in Orthopedic Surgery for People with Hemophilia. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:157-160. [PMID: 29911131 PMCID: PMC5990719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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26
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Hilberg T. Programmed Sports Therapy (PST) in People with Haemophilia (PwH) "Sports Therapy Model for Rare Diseases". Orphanet J Rare Dis 2018; 13:38. [PMID: 29506547 PMCID: PMC5836382 DOI: 10.1186/s13023-018-0777-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/15/2018] [Indexed: 12/30/2022] Open
Abstract
Sports and exercise therapy becomes more and more integrated in the treatment plan of different diseases. Although the benefits of this therapy are of high quality evidence, e.g. in cardiovascular diseases, no concepts of sports therapy are available as a treatment option for rare diseases. During the last eighteen years, we analyzed the situation as well as necessity, and developed a model, contents and the concept of the “Programmed Sports Therapy (PST)” for the treatment of PwH (people with haemophilia) as our model of rare disease. Many studies have shown that motoric skills are depressed in PwH, and that this gap to healthy people increases during age. The only way to reduce this progression is an appropriate therapy, adapted to the necessities of PwH. In haemophilia, in particular, physio- and sports therapy treatments should go hand in hand, the first in the acute phase after bleeding, the second later, after the acute phase has finished. One model, which considers all the different challenges, can be the cogwheel model presented here. Since haemophilia is a rare disease, new training concepts are necessary because classical group therapies are often impossible. PST based on the combination of sports therapy camps together with a supervised autonomous home training helps to directly bring the training to the trainee, in order to enhance key competences and improve the individual situation in PwH, and perhaps in patients with other rare diseases. The experience and scientific data substantiate the success of “Programmed Sports Therapy (PST)” and even this can be a model for other rare diseases.
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Affiliation(s)
- Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstr. 7, D-42285, Wuppertal, Germany.
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27
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Simultaneous bilateral total knee arthroplasty in patients with end-stage hemophilic arthropathy: a mean follow-up of 6 years. Sci Rep 2018; 8:1608. [PMID: 29371670 PMCID: PMC5785524 DOI: 10.1038/s41598-018-19852-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/08/2018] [Indexed: 12/31/2022] Open
Abstract
To investigate the safety, cost-effectiveness, and clinical outcomes of simultaneous bilateral total knee arthroplasty (TKA) in hemophilic arthropathy (HA), the requirements for transfusions, complications, costs, hospital stays, Hospital for Special Surgery (HSS) knee scores, knee range of motion (ROM) and revision rates were compared between simultaneous bilateral and unilateral TKA in HA patients. A total of 36 patients and 54 knees were included. Compared to the unilateral group, the bilateral group did not require more transfusions (2.39 ± 3.13 vs 0.83 ± 1.38 units of RBCs, p > 0.05) or consumption of coagulation factors (50091.67 ± 25168.5 vs 46477.78 ± 11348.32 IU, p > 0.05), complications rate (13/36 vs 6/18, p > 0.05), hospital stay (32.39 ± 19.77 vs 29.11 ± 12.67 days, p > 0.05), or costs excluding prostheses (14945.41 ± 6634.35 vs 14742.12 ± 5746.78 US dollars, p > 0.05). Additionally, the two groups exhibited similar medium-term knee HSS scores (83.67 ± 7.11 vs 81.00 ± 10.35, p > 0.05) and ROM (89.39° ± 13.66° vs 88.91° ± 12.90°, p > 0.05). Our data indicate that bilateral TKA is a safe and cost-effective treatment for HA with similar medium-term results compared to unilateral TKA.
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28
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Whitney KE, Liebowitz A, Bolia IK, Chahla J, Ravuri S, Evans TA, Philippon MJ, Huard J. Current perspectives on biological approaches for osteoarthritis. Ann N Y Acad Sci 2018; 1410:26-43. [PMID: 29265418 DOI: 10.1111/nyas.13554] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/18/2017] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
Abstract
Musculoskeletal injuries that disrupt the structure and function of diarthrodial joints can cause permanent biomechanical alterations and lead to a more severe, chronic condition. Despite advancements that have been made to restore tissue function and delay the need for joint replacement, there are currently no disease-modifying therapies for osteoarthritis (OA). To reduce the risk of OA, innovative preventive medicine approaches have been developed over the last decade to treat the underlying pathology. Several biological approaches are promising treatment modalities for various stages of OA owing to their minimally invasive nature and actively dynamic physiological mechanisms that attenuate tissue degradation and inflammatory responses. Individualized growth factor and cytokine therapies, tissue-engineered biomaterials, and cell-based therapies have revolutionary potential for orthopedic applications; however, the paucity of standardization and categorization of biological components and their counterparts has made it difficult to determine their clinical and biological efficacy. Cell-based therapies and tissue-engineered biologics have become lucrative in sports medicine and orthopedics; nonetheless, there is a continued effort to produce a biological treatment modality tailored to target intra-articular structures that recapitulates tissue function. Advanced development of these biological treatment modalities will potentially optimize tissue healing, regeneration, and joint preservation strategies. Therefore, the purpose of this paper is to review current concepts on several biological treatment approaches for OA.
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Affiliation(s)
- Kaitlyn E Whitney
- Steadman Philippon Research Institute, Vail, Colorado.,The Steadman Clinic, Vail, Colorado
| | | | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado
| | | | - Thos A Evans
- Steadman Philippon Research Institute, Vail, Colorado.,The Steadman Clinic, Vail, Colorado
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado.,The Steadman Clinic, Vail, Colorado
| | - Johnny Huard
- Steadman Philippon Research Institute, Vail, Colorado.,The University of Texas Health Science Center at Houston, Houston, Texas
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29
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Affiliation(s)
| | - Alexander D. Liddle
- NIHR Clinical Lecturer, University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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