Abstract
BackgroundTotal 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.MethodsA 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.ResultsThe 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.ConclusionsAlthough 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 registrationThe study was retrospectively registered in WHO ICTRP under identifier KCT0002404 (date of registration: August 04, 2017).
Highlights
Total knee arthroplasty (TKA) has become the treatment of choice for end-stage hemophilic arthropathy of the knee
Blood management has been an issue in perioperative care in general TKA and especially in hemophilia, inappropriate perioperative blood management in the hip and knee arthroplasty is the most important cause of affecting the clinical outcome [1,2,3,4]
bolus injections (BI) was administered using the standard protocol of our center; the first bolus of 50 IU/kg was given 30 min before surgery to achieve a preoperative factor VIII (FVIII) level of 100%; BI continued for 3 days after operation [9]
Summary
Total knee arthroplasty (TKA) has become the treatment of choice for end-stage hemophilic arthropathy of the knee. 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. Blood management has been an issue in perioperative care in general TKA and especially in hemophilia, inappropriate perioperative blood management in the hip and knee arthroplasty is the most important cause of affecting the clinical outcome [1,2,3,4]. Park et al BMC Musculoskeletal Disorders (2017) 18:356 different methods of coagulation factor replacement for major surgery in patients with hemophilia. This study was performed to explore the effectiveness and safety of CI in hemophilia A patients that underwent TKA, by comparing CI with BI
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