The Efficiency of Substitutive Treatment with Moroctocog Alfa in Managing Hemostasis in Patients with Hemophilia A Without Inhibitors With Total Knee Arthroplasties

Abstract

Hemophilia A is a hereditary coagulopathy caused by the deficiency of the coagulation factor VIII, whose main complication consists in disabling arthropathy. The most often affected joint is the one of the knee, due to which this article aims at presenting, on one hand, the role of continuous substitutive prophylactic treatment in preventing the onset of this complication and, on the other hand, the current view of orthopedic surgery in managing the above-mentioned complication. The continuous prophylactic treatment represents the best therapeutic conduct in preventing the onset of hemophilic arthropathy, yet this aspect is limited by two important factors: inappropriate medical support, dependence on the social and economic level of every country and inappropriate adherence of the patient to this thorough treatment, which represents a challenge for a life with no bleeding. Under the circumstances imposed by an insufficient substitutive treatment or by a deficient adherence of the patient to this, recurrent hemarthrosis shall lead to cartilage destruction and synovial hypertrophy (synovitis), which will impose, in time, total endoprosthesis in order to re-establish the motor function and to improve the life quality of the hemophilic patient. The surgery of the hemophilic patient is associated with an increased risk of hemorrhage and infection and it is practiced only with substitutive hematologic support. The key to the best results is the existence of a multidisciplinary experienced team, including an orthopedist, hematologist, physical therapist.