Outcome of total knee arthroplasty for end-stage type A hemophilic arthropathy.

Abstract

Objective To evaluate the outcome of total knee arthroplasty (TKA) for end-stage hemophilic arthropathy, the effectiveness and safety of factor Ⅷ replacement treatment, and the selection of prothesis. Methods Nineteen patients (25 knees) with type A hemophilic arthropathy underwent TKA from June 2003 to April 2009. The average age at index operation was 33.4 years old (range, 18-54 years). The level of coagulation factor for replacement treatment was 100% on operation day, >80% within 3 days after operation, >60% from the third day to the seventh day after operation. Clinical assessment included hospital for special surgery knee score(HSS), pain symptom, range of motion(ROM) and complication. Results Eigh-teen patients(24 knees) were followed-up, and the average duration was 31 months(range, 7-54 months). The average preperative HSS score was 51±14 (31-64), whereas the average postoperative HSS score was 86±9.5 (62-110). The average preoperative ROM was 55°±26.3°(60°-100°), whereas the average postoperative ROM was 82°±18.6°(10°-100°). Flexion contracture had improved from 19°±13°(0°-45°) preoperatively to 2.7°± 3.2°(0°-10°) postoperatively. The average serum factor Ⅷ level was 74.07% between the first day and the fifth day after operation. As for postoperative complication, one had a hemarthrosis and one had a paralysis of common peroneal nerve. One patient underwent revision surgery because of infection of femoral compo-nent 17 months later. Conclusion TKA is an effective treatment for end-stage bemophilic arthropathy of knee joint, it can provide good outcome and improve the quality of life. Reasonable factor Ⅷ replacement is the basis of successful treatment program. Key words: Hemophilia A ; Knee joint; Factor Ⅷ; Arthroplasty,replacement,knee