Italian researchers published a study in the April issue of the British Journal of Haematology in which they evaluated the safety and efficacy of total knee replacement (TKR) in patients with hemophilia. Chronic bleeding into the knee joint, a common target joint for many patients with moderate to severe hemophilia, causes pain and impairs movement. Ongoing joint damage can result in loss of motion and mobility. Anecdotal evidence and previous studies suggest that a successful TKR can improve mobility and a patient’s quality of life. Investigators reviewed the results of 116 TKR procedures performed at a single institution during a 14-year period. The lead author was Pier Luigi Solimeno, MD, from the Haemophilic Arthropathy Treatment Centre, Maria Grazia Gatti Randi Hospital in Milan, Italy.
The outcomes of the knee replacement surgery were determined through a series of post-surgical tests, including one that measured range of motion. A “knee-rating scale” from a local Hospital of Special Surgery was also used in the evaluations, which were conducted an average of 5.1 years after the procedure. In all, 96 prostheses inserted at the time of the TKR (83%) were still in place. Outcomes between HIV-positive and HIV-negative patients were comparable. However, success rates were significantly lower in patients with inhibitors compared to those without (44% vs. 87%). Data on the remaining patients showed that 16 prostheses (14%) were removed, nine from infection and seven as a result of aseptic loosening, in which the artificial components wear out or decay, causing pain and stiffness.
“These results show that TKR represents a safe and effective procedure in haemophiliacs if performed by a highly experienced surgeon,” concluded the authors.
One of the co-authors of the study was Pier M. Mannucci, MD, from the Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Medicine and Medical Specialties in Milan. Mannucci is a member of the National Hemophilia Foundation’s Medical and Scientific Advisory Council (MASAC).
Source: Solimeno L, Mancuso M, Pasta G, et al. Factors influencing the long-term outcome of primary total knee replacement in haemophiliacs: a review of 116 procedures at a single institution. British Journal of Haematology, April 2009; 145 (2): 227-234.