Total knee arthroplasty in severe haemophilic patients under continuous infusion of clotting factors

摘要

Purpose: Haemophilic arthropathy is painful, invalidating and destructive. Authors report a prospective study of total knee arthroplasties in patients with severe haemophilia under continuous infusion of clotting factors. The purpose is to evaluate the benefits of continuous infusion of clotting factors regarding long-term functional improvement and radio-clinical results. Methods: From 1998 to 2009, 20 total knee arthroplasties were implanted in 14 patients with a mean age of 36. 5 years (24-56). A continuous infusion of anti-haemophilic factors was used and supervised by the physician of the Regional Haemophilia Treatment Centre (CRTH). Evaluation was clinical using the HSS and Oxford scores and radiological. Results: One patient was lost to follow-up. Median follow-up is 66. 5 months (6-134). Oxford score at latest follow-up is 42 (37-46). On revision, HSS score is 91 (84-96). Median flexion gain is 32. 5° (-20; 75°). There is a median flexion contracture of 5° (0-15°) and a median extension improvement of 22. 5°. We report 2 secondary infectious complications, concerning the same operated knee of a single patient. No post-operative haematoma was reported in our study. Conclusion: Total knee arthroplasty in haemophilic arthropathy improves both the function and quality of life of this group of patients. Continuous infusion of clotting factors contributes significantly to these results, by allowing early and intensive rehabilitation, and offers security regarding haemorrhagic complications commonly described in the literature and that we have not encountered in our study. Level of evidence: Therapeutic study, Level IV.