Periarticular aneurysm following total knee replacement in hemophilic arthropathy. A case report.

Abstract

Hemophilia is an X-linked disorder characterized by a tendency to hemorrhage due to the lack of production of clotting factors VIII and IX. The worldwide prevalence of hemophilia A and B are one in 10,000 and one in 25,000, respectively1. Hemarthrosis is common in patients with hemophilia. Large joints, such as the knee, ankle, and elbow, are particularly prone to recurrent bleeding. Bleeding may occur preferentially into a particular joint, which may become the so-called target joint. Rarely, a periarticular aneurysm that bleeds may present as a hemarthrosis2-5 and can lead to a situation that is not responsive to the standard treatment with clotting-factor replacement. This is an extremely rare occurrence in hemophilic patients and has been reported only once6, to our knowledge. We are reporting a case of periarticular aneurysm following total knee replacement in hemophilic arthropathy. The patient's consent was obtained prior to submission of this case report. Athirty-four-year-old man with severe hemophilia A had had recurrent bleeding into the left knee since he was fourteen years old. The left knee subsequently became a target joint. A typical episode involved trauma or strenuous exercise followed by the development of joint swelling over twenty-four hours. In the previous five years, the patient had experienced progressively worsening pain and stiffness, occasional locking, and reduced mobility. On examination, there was gross deformity of the knee joint with a limited range of movement (0° to 90°), synovial thickening, and an effusion. An arthroscopic examination of the left knee performed eighteen months prior to surgery had shown Outerbridge7 grade-4 degenerative changes of the medial compartment and grade-2 changes affecting the lateral compartment. The patient underwent a left total knee arthroplasty. The patient received a preoperative bolus followed by continuous infusion of factor VIII to raise …