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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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Yuan D, Zhang QS, Zhang K, Cao YW, Chen GH, Ling ZZ, Xu H. Total Knee Arthroplasty Using a Medial Pivot or Posterior Cruciate-Stabilizing Prosthesis in Chinese Patients. J Knee Surg 2020; 33:892-898. [PMID: 31064021 DOI: 10.1055/s-0039-1688784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an unmet need for a prosthesis designed according to the anatomical parameters of the Chinese population. This study aims to compare the use of a medial pivot (MP) implant or posterior cruciate ligament (PCL) substitution (posterior-stabilized [PS]) prosthesis for unilateral total knee arthroplasty (TKA) in a Chinese population. The medical records of patients undergoing unilateral TKA with an MP implant (Group A) or a PS prosthesis (Group B) at our institution between January 2010 and December 2011 were retrospectively reviewed. Patients were followed up for 5 years. Preoperatively and at the December 2016 postoperative follow-up, the Hospital for Special Surgery scoring system (HSS knee score) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were measured to evaluate TKA outcomes. This study included 49 patients in Group A and 51 in Group B. As of December 2016, there were no significant differences in the preoperative/postoperative changes in any category of the HSS knee score or WOMAC score between the groups. There were no postoperative complications in either group during the 5-year follow-up. There were no periprosthetic infections or need for revision surgery. One patient in Group A experienced aching and a small amount of effusion in the articular cavity that was attributed to overexertion. In conclusion, there were no significant differences in midterm outcomes in Chinese patients receiving an MP implant or a PS prosthesis for unilateral TKA. These data suggest that the MP and PCL substitution design are safe and effective for unilateral TKA in China.
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Affiliation(s)
- Ding Yuan
- Department of Emergency Medicine, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
| | - Quan-San Zhang
- Department of Emergency Medicine, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
| | - Kun Zhang
- Department of Urology, Qingdao Eighth People's Hospital, Qingdao, Shandong, China
| | - Yan-Wei Cao
- Department of Urology, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong, China
| | - Guan-Hong Chen
- Department of Orthopedics, Shanxian Central Hospital, Shanxian, Shandong, China
| | - Zong-Zhun Ling
- Department of Emergency Medicine, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
| | - Hui Xu
- Department of Anesthesiology, Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
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Oyarzun A, Barrientos C, Barahona M, Martinez Á, Soto-Arellano V, Courtin C, Cruz-Montecinos C. Knee haemophilic arthropathy care in Chile: Midterm outcomes and complications after total knee arthroplasty. Haemophilia 2020; 26:e179-e186. [PMID: 32311196 DOI: 10.1111/hae.14004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) can improve knee function in the general population, but challenges arise for TKA use in haemophilic patients (HPs). AIM This study aimed to evaluate the midterm clinical experience of a single medical centre in TKA in HPs. METHODS We performed a case series of consecutive TKAs from 2007 to 2013 in HPs. All patients received coagulation factor supplementation according to the institutional protocol. Surgery was performed without a tourniquet by a standard midline medial parapatellar approach. We compared the range of motion (ROM) and flexion contracture before surgery and 1-year postoperative using paired Wilcoxon-non-parametric test (P < .05 was considered significant). The need for revision surgery was considered TKA survival failure. RESULTS Forty-one HP/60 TKAs were reviewed (19 cases were bilateral). Preoperative median ROM and flexion contracture was 75° (range, 0°-95°) and 20° (range, 5°-80°), respectively. The postoperative median ROM increased to 83° (range, 45°-110°), and median flexion contracture decrease to 0° (range, 0°-40°) a statistically significant difference (P < .01). Postoperative median clinical Knee Society Score (KSS) and functional KSS were 88 (range, 59-97) and 100 (range, 30-100), respectively. Six patients required revision (6.66%) due to infection. TKA survival at 5 years was 92% (range, 82%-96%). CONCLUSION This study supports that TKA improves function and ROM in haemophilic knee arthropathy. The protocol of coagulation factors used in this cohort is valid as no related complications were reported. A higher incidence of complications, especially infections, must be expected compared with a TKA in non-HPs.
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Affiliation(s)
- Andrés Oyarzun
- Department of Orthopaedic Surgery, Hospital San Jose, Santiago, Chile
| | - Cristian Barrientos
- Department of Orthopaedic Surgery, Hospital San Jose, Santiago, Chile.,Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Maximiliano Barahona
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Álvaro Martinez
- Department of Orthopaedic Surgery, Hospital San Jose, Santiago, Chile
| | - Verónica Soto-Arellano
- Centre of Haemophilia and Studies of Congenital Coagulopathies, Roberto del Rio Children's Hospital, Santiago, Chile
| | - Carolina Courtin
- Department of Orthopaedic Surgery, Hospital San Jose, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Biomechanics and Kinesiology Laboratory, Service of Physical Therapy, San José Hospital, Santiago, Chile
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Park YS, Shin WJ, Kim KI. Comparison of continuous infusion versus bolus injection of factor concentrates for blood management after total knee arthroplasty in patients with hemophilia. BMC Musculoskelet Disord 2017; 18:356. [PMID: 28830476 PMCID: PMC5568057 DOI: 10.1186/s12891-017-1720-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/11/2017] [Indexed: 12/15/2022] Open
Abstract
Background Total knee arthroplasty (TKA) has become the treatment of choice for end-stage hemophilic arthropathy of the knee. Theoretically in hemophilia A, perioperative continuous infusion (CI) of factor VIII (FVIII) would provide a more consistent FVIII level than general bolus injections (BI) in TKA. Current study was designed to evaluate the effectiveness of CI of coagulation factor concentrates during the perioperative period compared to BI. Methods A total of 42 TKAs were performed in 31 patients with severe hemophilia A. Under the supervision of a multidisciplinary hemophilia team, CI and BI were monitored during application of a standardized regimen. Perioperative clinical parameters including postoperative hemoglobin drop, drained blood volume, transfusion rate, total consumption of FVIII, and perioperative complications were assessed. Results The difference in the postoperative hemoglobin drop was significant between two groups with a lower decrease in the CI group (p = 0.002). The drained blood volume for postoperative 24 h was significantly lower in the CI than the BI groups (p = 0.037). Total consumption of factor concentrates for postoperative 5 days was greater in the CI group than in the BI group (p = 0.000). One postoperative hematoma and wound dehiscence occurred in BI group and no other complication developed. Conclusions Although good control of hemostasis could be achieved using either method during the perioperative period of TKA, CI seems more tolerable and effective than BI to provide perioperative blood management undergoing TKA in patients with hemophilia. Trial registration The study was retrospectively registered in WHO ICTRP under identifier KCT0002404 (date of registration: August 04, 2017).
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Affiliation(s)
- Young Shil Park
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892, Dongnam-ro, Gangdong-Gu, Seoul, 05278, Korea
| | - Won-Ju Shin
- Department of Orthopedic Surgery, Kyung Hee University Medical Center, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 0244, Korea
| | - Kang-Il Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892, Dongnam-ro, Gangdong-Gu, Seoul, 05278, Korea.
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Holderness BM, Goto Y, McKernan L, Bernini P, Ornstein DL. Thromboprophylaxis and Outcomes for Total Joint Arthroplasty in Congenital Bleeding Disorders. Clin Appl Thromb Hemost 2016; 22:563-8. [DOI: 10.1177/1076029616643821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Total joint arthroplasty (TJA) improves the quality of life for patients with end-stage osteoarthritis but is associated with an increased risk of venous thromboembolism (VTE), thus pharmacologic thromboprophylaxis is recommended for most patients. Patients with congenital bleeding disorders may develop severe arthropathies due to repeated hemarthroses and derive similar benefit from TJA as the general population. No guidelines for pharmacologic thromboprophylaxis in this population exist, however, as the risks and benefits are not well defined. We undertook the current study to assess the safety and efficacy of pharmacologic VTE prophylaxis in patients with congenital bleeding disorders undergoing TJA. We retrospectively reviewed the medical records of patients with bleeding disorders who underwent TJA at our academic institution between 1987 and 2012. We identified 28 patients who underwent 38 TJA procedures. Low-molecular-weight heparin (LMWH) was administered in 29 procedures (76%) and was discontinued early in 3 procedures (2 patients) due to nonjoint bleeding. No symptomatic VTE was identified, and no joint or deep wound infections were seen. Twenty-two patients accounting for 31 procedures were contacted to discuss their experience with TJA. All reported decreased pain, and 97% reported improved function after the surgery. Impressively, 97% stated that they would choose to have the surgery again. These results confirm the benefit of TJA in patients with congenital bleeding disorders and end-stage arthropathies and suggest that LMWH thromboprophylaxis is safe. No patient in our cohort developed symptomatic VTE, whether or not thromboprophylaxis was administered, thus necessity of thromboprophylaxis remains an unanswered question.
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Affiliation(s)
- Britt M. Holderness
- Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | - Yuika Goto
- Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | - Laurel McKernan
- Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | - Philip Bernini
- Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | - Deborah L. Ornstein
- Hemophilia & Thrombosis Center, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
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