Abstract
To investigate the safety, cost-effectiveness, and clinical outcomes of simultaneous bilateral total knee arthroplasty (TKA) in hemophilic arthropathy (HA), the requirements for transfusions, complications, costs, hospital stays, Hospital for Special Surgery (HSS) knee scores, knee range of motion (ROM) and revision rates were compared between simultaneous bilateral and unilateral TKA in HA patients. A total of 36 patients and 54 knees were included. Compared to the unilateral group, the bilateral group did not require more transfusions (2.39 ± 3.13 vs 0.83 ± 1.38 units of RBCs, p > 0.05) or consumption of coagulation factors (50091.67 ± 25168.5 vs 46477.78 ± 11348.32 IU, p > 0.05), complications rate (13/36 vs 6/18, p > 0.05), hospital stay (32.39 ± 19.77 vs 29.11 ± 12.67 days, p > 0.05), or costs excluding prostheses (14945.41 ± 6634.35 vs 14742.12 ± 5746.78 US dollars, p > 0.05). Additionally, the two groups exhibited similar medium-term knee HSS scores (83.67 ± 7.11 vs 81.00 ± 10.35, p > 0.05) and ROM (89.39° ± 13.66° vs 88.91° ± 12.90°, p > 0.05). Our data indicate that bilateral TKA is a safe and cost-effective treatment for HA with similar medium-term results compared to unilateral TKA.
Highlights
Total knee arthroplasty (TKA) has been considered an optimal choice for treatment of HA10–16, and factor replacement therapy (FRT) is imperative in maintaining an adequate level of clotting factors to minimize blood loss perioperatively[8,17,18]
No significant differences in age, weight, type of hemophilia and comorbidities were noted between the two groups
Preoperative lab result analysis revealed no significant differences in preoperative hemoglobin (Hb), prothrombin time (PT), activated partial thromboplastin time (APTT) and coagulation factor activity between the two groups (Table 1)
Summary
Total knee arthroplasty (TKA) has been considered an optimal choice for treatment of HA10–16, and FRT is imperative in maintaining an adequate level of clotting factors to minimize blood loss perioperatively[8,17,18]. Given that HA of both knees is often involved, bilateral TKA is always unavoidable in the end stage. As staged bilateral TKA requires repeated clotting factor infusions that may induce the development of inhibitory against coagulation factors[19,20] as well as increases in hospitalization costs, simultaneous bilateral TKA may be considered a better treatment option. We conducted this retrospective study of 36 patients with a mean follow-up of 6 years to investigate the safety, cost-effectiveness, and medium- and long-term clinical outcomes of patients with end-stage HA receiving simultaneous bilateral TKA compared to unilateral TKA. We propose a hypothesis that the clinical results of simultaneous bilateral TKA were not inferior to unilateral TKA in HA patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
