Haemophilic Arthropathy Of Knee Research Articles

Accuracy and clinical role of digital templating for total knee arthroplasty performed on haemophilic knees.

In total knee arthroplasty (TKA), choosing the correct implant size is important. There is lack of data on accuracy of templating on haemophilic knees. Our aim was to test the accuracy of 2D digital templating for TKA on haemophilic arthropathy (HA) of knee. TKAs performed on HA between January 2011 and January 2022 were screened. Osteoarthritis (OA) group was created as control group by a one-to-one matching regarding type of implant used. Intra- and interobserver correlations were measured in HA, then correlation between templated and implanted sizes was investigated in four assessments (femur AP, femur lateral, tibia AP, tibia lateral), then compared with OA group. Fifty-eight knees in each group included. Regarding intraobserver correlation in HA, there was excellent correlation for femur AP [.93 (.73-.98)], femur lateral [.98 (.91-.99)], and tibia AP (1.0) templating. Regarding interobserver correlation in HA, excellent correlation was observed for femur lateral [.93 (.74-.98)] and tibia AP templating [.90 (.65-.97)]. Regarding correlation of templated and applied sizes in HA; tibia AP, tibia lateral and femur lateral templating showed good correlation [.81 (.70-.89),.86 (.77-.91),.79 (.67-.87) while femur AP templating showed moderate correlation [.67 (.50-.79)]. Comparing HA and OA, there was no difference in correlation levels regarding femur AP, femur lateral, tibia AP and tibia lateral templating (p=.056, p=.781, p=.761, p=.083, respectively). Although 2D digital templating shows comparable correlation in HA and OA, clinical applicability of templating on HA appears to be limited in its current state.

Outcome measures analysis following total knee arthroplasty in patients with severe haemophilic arthropathy of the knee.

Total knee arthroplasty (TKA) has been the gold standard for treating severe haemophilic arthropathy of the knee when all conservative measures fail. However, performing a TKA in patients with haemophilic arthropathy is difficult due to severe joint deformity and destruction, and poor bone quality. The aim of the present study was to evaluate the short-term results of TKA in the treatment of knee haemophilic arthropathy in a tertiary referral centre, with an emphasis on health-related quality of life and knee function. A prospective study was conducted that included 19 male patients with end-stage haemophilic knee arthropathy who underwent TKA in a tertiary referral centre. Clinical outcome and health-related quality of life were assessed by the Western Ontario and McMaster Universities Arthritis (WOMAC) index and the Short Form-36 (SF-36) both pre-operatively and at 1-year post-operatively. The mean age of the patients was 50.37±7.63 years (range, 40-65 years). Pre-operative health-related quality of life was impaired in all patients in all SF-36 domains but was markedly improved after TKA. Knee function in all dimensions (pain, stiffness and physical function), as measured by the WOMAC questionnaire, significantly improved after TKA. Pre-operative pain, stiffness and function, along with total WOMAC score, were strongly and negatively correlated with pre-operative SF-36. Overall, the present study indicated a significant improvement in quality of life and clinical outcome after TKA in patients with advanced haemophilic arthropathy. More studies with longer follow-up periods in a larger population are needed to fully elucidate the mid- and long-term values of TKA in haemophilic patients.

Safety and efficacy of a self-induced myofascial release protocol using a foam roller in patients with haemophilic knee arthropathy.

BackgroundHaemophilic knee arthropathy presents functional and structural alterations and chronic pain. Self‐induced myofascial release aims to treat fascial restrictions and improve functionality.AimThis study investigated the safety and effectiveness of a self‐induced myofascial release protocol in patients with haemophilic knee arthropathy.MethodsTwenty‐five patients with bilateral haemophilic knee arthropathy were recruited (n = 50 knees). The patients followed an intervention protocol, with daily exercises for 8 weeks. The dependent variables were: safety of the technique (periodic telephone monitoring), joint state (Haemophilia Joint Health Score), pain intensity (visual analogue scale), pressure pain threshold (pressure dynamometer), range of motion (universal goniometer) and hamstring flexibility (Fingertip‐To‐Floor test). The resulting values were measured at baseline (T0) and after the intervention (T1). Paired t‐test compared the means between the assessments. Effect size was obtained using Cohen's d mean difference formula. The minimum detectable change of each variable was calculated.ResultsThere were no cases of joint bleeding either during or after the procedure. The results showed improvements after the experimental period in joint state (Mean difference [MD]: 1.38; 95% confidence interval [95%CI]: .94;1.81), pain intensity (MD: 1.19; 95%CI: .70;1.67), pressure pain threshold (MD: ‐23.25; 95%CI: ‐26.25;‐19.84), flexion (MD: ‐4.36; 95%CI: ‐5.70;‐3.01), loss of extension (MD: 4.10; 95%CI: 3.01;5.18) and hamstring flexibility (MD: 3.54; 95%CI: 2.61;4.46).ConclusionsMyofascial self‐release using a foam roller is safe in patients with haemophilic knee arthropathy. A myofascial self‐release protocol can improve perceived pain, range of motion and knee joint status, as well as hamstring flexibility in patients with haemophilic knee arthropathy.

The effectiveness of manual therapy in addition to passive stretching exercises in the treatment of patients with haemophilic knee arthropathy: A randomized, single-blind clinical trial.

Haemophilic arthropathy is characterized by joint restrictions. One of the most affected joints in haemophilia patients is the knee. This study evaluates the effectiveness of manual therapy and passive muscle stretching exercises for reducing the frequency of hemarthrosis and pain and improving joint health and range of motion in patients with haemophilic knee arthropathy. Twenty eight patients with haemophilic knee arthropathy were randomized to an experimental group or to a control group (without intervention). Manual therapy sessions included joint traction and gliding manoeuvers, in addition to passive muscle stretching. The intervention included one 60-minute with two weekly sessions over a 12-week period. We evaluated the frequency of knee hemarthrosis (self-reporting), joint health (Hemophilia Joint Health Score), range of motion (goniometry) and perceived knee pain (visual analogue scale). A baseline evaluation was performed at the end of the intervention and after a 12-week follow-up period. The frequency of hemarthrosis dropped significantly in the experimental group compared to the control group (F=11.43; P<.001). Compared to the control group, the experimental group had consistently better results in the variables for joint health (F=13.80; P<.001), range of motion in knee flexion (F=24.29; P<.001) and loss of extension (F=8.90; P<.001), and perceived pain (F=49.73; P<.001). Manual therapy using joint traction and gliding manoeuvers, in addition to passive muscle stretching, reduces the frequency of hemarthrosis in patients with haemophilia. Manual therapy with passive muscle stretching exercises improves joint health, range of motion and perceived joint pain.

Knee haemophilic arthropathy care in Chile: Midterm outcomes and complications after total knee arthroplasty.

Total knee arthroplasty (TKA) can improve knee function in the general population, but challenges arise for TKA use in haemophilic patients (HPs). This study aimed to evaluate the midterm clinical experience of a single medical centre in TKA in HPs. We performed a case series of consecutive TKAs from 2007 to 2013 in HPs. All patients received coagulation factor supplementation according to the institutional protocol. Surgery was performed without a tourniquet by a standard midline medial parapatellar approach. We compared the range of motion (ROM) and flexion contracture before surgery and 1-year postoperative using paired Wilcoxon-non-parametric test (P<.05 was considered significant). The need for revision surgery was considered TKA survival failure. Forty-one HP/60 TKAs were reviewed (19 cases were bilateral). Preoperative median ROM and flexion contracture was 75° (range, 0°-95°) and 20° (range, 5°-80°), respectively. The postoperative median ROM increased to 83° (range, 45°-110°), and median flexion contracture decrease to 0° (range, 0°-40°) a statistically significant difference (P<.01). Postoperative median clinical Knee Society Score (KSS) and functional KSS were 88 (range, 59-97) and 100 (range, 30-100), respectively. Six patients required revision (6.66%) due to infection. TKA survival at 5years was 92% (range, 82%-96%). This study supports that TKA improves function and ROM in haemophilic knee arthropathy. The protocol of coagulation factors used in this cohort is valid as no related complications were reported. A higher incidence of complications, especially infections, must be expected compared with a TKA in non-HPs.

Challenges in successful management of haemophilic knee arthropathy: Our experience in a tertiary centre

BackgroundHaemophilia is characterized by a partial or complete deficiency of clotting factor VIII or IX. The repeated bleeding episodes into the joints contributes to subsequent chronic arthropathy which debilitates the patient and affects the quality of life. There are lot of hurdles in successful management of such patients. We present our experience in dealing such patients. Materials and Methods24 patients (27 knees) with haemophilic knee arthropathy were included. The preoperative VAS (Visual Analogue Scale) and KSS (Knee Society Score) were assessed. All underwent total knee arthroplasty with stemmed constrained prosthesis. Postoperatively VAS and KSS were analysed at the end of 12 months. ResultsThe mean preoperative VAS was 8.2 (Range: 7–10), mean KSS clinical score was 39.9 (Range: 12–61) and mean KSS functional score was 51.4(Range: 20–70). The mean postoperative VAS was 2.7(Range: 2–4), mean KSS clinical score was 70.5 (Range: 61–80) and mean KSS functional score was 74.2(Range: 60–80). There was statistical significant difference between preoperative and post-operative scores. At the end of 12 months, 17 patients (63%) had good outcome, seven patients (26%) had fair and three patients (11%) had excellent outcome as per the KSS scores. ConclusionsTotal knee arthroplasty has good outcome with respect to clinical as well as functional outcome in haemophilic arthropathy. Although the results and outcome of total knee arthroplasty in haemophilic knee arthropathy may still be inferior to the results seen in a normal individual, a multidisciplinary approach yields a better functional and quality of living in such haemophilic patients.

Efficacy, safety, and synovial effects of intra-articular hyaluronic acid in treating recalcitrant hemophilic arthropathy of knee joint

Background and Aim: Recurrent hemarthrosis results in synovitis and destructive arthropathy in hemophilic patients. The aim of our study was to investigate the efficacy and synovial changes with viscosupplementation therapy in treating hemophilic arthropathy of the knee. Subjects and Methods: Twenty hemophilic patients who had painful arthropathy of the knee with synovitis were enrolled. Patients received three weekly intra-articular injections of 2 mL hyaluronic acid (HA). The synovial thickness and vascularity determined by ultrasonography, visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form 36 (SF-36) were compared initially and at 1, 2, 3, and 6 months after the first injection. Statistical analysis was performed using SPSS version 20 software (Armonk, NY, USA: IBM Corp). Results: There were 19 hemophilia A patients and 1 hemophilia B patient. A total of 26 knees received viscosupplementation therapy. Significant improvement in VAS, SF-36, WOMAC score, hyperemia, and thickness of suprapatellar recess synovium from baseline was seen up to 6 months after intra-articular HA injection. No severe injection-related adverse event was observed. Conclusions: This study suggests that three weekly intra-articular HA injections are safe and effective in treating hemophilic arthropathy of knee with synovitis for a period up to 6 months. The treatment not only improved quality of life, pain and knee function but also reduced synovial thickness and hyperemia. HA viscosupplementation therapy could serve as an adjunctive therapy before arthroscopic synovectomy or total knee arthroplasty.

Constrained Rotating Hinge Prostheses in Severe Haemophilic Knee Osteoarthritis

The purpose of this experimental study is to present the design and biomechanical characteristics of cemented total knee prostheses type rotating-hinge RT-PLUS® (Smith and Nephew), as well as to evaluate their use in severe haemophilic knee arthropathy with major bone damage, ligamentous lesions, axial deviations and muscle retractions. We retrospectively evaluated 5 patients with severe haemophilic arthropathy with an average age of 48.5years. The functional results are good, with a significant improvement of range of motion (ROM) and pain relief resulting in a much better life quality. We did not have any stem loosening or any other complications except 2 wound healing problems which were treated successfully. The authors recommend this type of arthroplasty in severe haemophilic knee arthropathy or in any primary knee osteoarthritis with severe bone loss or any kind of ligamentous lesions.

Clinical outcomes of arthroscopic synovectomy for adolescent or young adult patients with advanced haemophilic arthropathy.

The aim of the present study was to assess the clinical outcomes of arthroscopic synovectomy in adolescent or young adult patients with advanced haemophilic arthropathy. From January 2009-January 2012, clinical data from 11 adolescent or young adult patients with advanced haemophilic arthropathy who were treated with arthroscopic synovectomy were retrospectively collected. The mean follow-up period was 71.91±5.28 months. The evaluated indicators included frequency of joint bleeding, range of motion (ROM), X-ray staging, hospital for special surgery (HSS) knee score and HSS pain scores. Joint bleeding frequency, pain degree and HSS scores significantly improved following arthroscopic synovectomy at the end of the follow up period. The ROM did not significantly improve. Among the 11 patients, radiographic stage remained unchanged in 9 cases whereas the remaining 2 cases progressed from stage IV to stage V. No patients required total knee arthroplasty through the end of the follow-up period. These findings suggested that arthroscopic synovectomy appears to an effective treatment option to decrease the frequency of bleeding and knee pain, improve knee function and delay knee joint arthroplasty to a certain extent for adolescent or young adult patients with advanced haemophilic knee arthropathy.

Clinical and radiologic results after open-wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity.

The previous studies have described only closed-wedge high tibial osteotomy (HTO) in haemophilic arthropathy (HA). The purpose of this study was to evaluate clinical and radiographic results after open-wedge HTO in HA with varus knee deformity. We included 13 open-wedge HTOs in HA performed between 2005 and 2016. The mean age of patients was 28.9years. Visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC), and range of motion (ROM) indices were assessed. Any complications or requirements for total knee arthroplasty (TKA) were investigated. Mechanical axis (MA), minimal joint space width (mJSW) and Pettersson score were measured. Bone union rates at 3 and 6months postoperative were evaluated. VAS improved from 5.1 to 2.4 (P<.001). WOMAC was 66.5 preoperatively, and 26.6 postoperatively (P<.001). Pre- and postoperative ROM did not differ significantly. There were no cases of HTO converted to TKA, but one case of HTO required TKA 152months postoperative. No complications were observed. The MA was corrected from varus 5.1° to valgus 1.2° (P<.001). Pre- and postoperative mJSW did not significantly differ. Pettersson score improved from 3.84 to 2.47 (P<.001). The bone union rates at the osteotomy gap were 45.2% and 67.8% at 3 and 6months postoperative. Open-wedge HTO should be considered in cases of HA with varus deformity in young haemophilic patients, even though inflammatory arthritis is not an optimal indication for this procedure. It can be an appropriate treatment with respect to the choice to postpone TKA.

Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost-effective procedure?

Haemophilic arthropathy of the knee is usually a bilateral affliction. The patients usually refer for treatment in young ages and do not have major comorbidities, being fit for bilateral simultaneous total knee arthroplasty. In this study, we assessed the safety and cost-effectiveness of simultaneous bilateral surgery in patients with haemophilia. Between April 2010 and April 2012, eight patients (16 knees) underwent bilateral simultaneous and 19 patients (19 knees) underwent unilateral total knee arthroplasty (TKA) at our institution. We compared the range of motion and flexion contracture, KSS, WOMAC knee score and SF36 quality of life score between two groups. The duration of hospital stay, coagulation factor consumption and all inpatient costs were recorded. The average follow-up was 26 and 29months in unilateral and bilateral groups respectively. At the conclusion of the study, the KSS and WOMAC and SF36 scores were not significantly different between the two groups. Mean ROM and flexion contracture did not differ significantly. The mean length of hospital stay was 15days for bilateral patients and 12days for unilateral patients, the difference being non-significant. None of our patients needed transfusion in any group. The cost of simultaneous bilateral TKA was about half of the expenses of staged bilateral TKA. Simultaneous bilateral TKA seems to be a safe and cost-effective approach without increasing the rate of complications in patients' bilateral haemophilic knee arthropathy. The procedure is, at least, as effective as staged unilateral knee arthroplasty in improving the patients' quality of life.

Elective total knee arthroplasty in haemophilic patients. Proposal for a clinical pathway.

Total knee arthroplasty (TKA) provides significant pain relief and better function in patients with end-stage haemophilic knee arthropathy. Peri- and postoperative care tends to be more complex than in non-haemophilic patients undergoing TKA and requires a multidisciplinary team approach. The implementation of standardized clinical pathways in non-haemophilic patients undergoing TKA has been shown to increase quality of care and to reduce postoperative complication rates. Consequently, the use of clinical pathways in haemophilic patients undergoing TKA may be beneficial to this particular subpopulation of patients. A clinical pathway for TKA for haemophilic patients was designed in a consensus process involving all participating departments. We propose a specifically adjusted clinical pathway for TKA for haemophilic patients to show that standardization of elective orthopaedic surgery in haemophilia is feasible. The authors emphasize that there are limitations on categorizing haemophilic patients and stress that individual interdisciplinary treatment should take precedence over a standardized approach.

Haemophilic knee arthropathy: long-term outcome after total knee replacement

The objective of this study was to evaluate the long-term outcome and prosthetic survival of primary total knee arthroplasty in haemophilic patients. It was hypothesized that the infection and revision rate are higher and the outcome inferior when compared with patients without haemophilia. Between 1985 and 2004, forty-three consecutive primary total knee replacements were performed in thirty haemophilic patients. These patients' charts were reviewed retrospectively. Twenty-five patients (34 knees) were available for clinical and radiological follow-up. The outcome was assessed using the Knee Society score, WOMAC and Kaplan-Meier survivorship analysis. An haematogenous infection occurred in two patients. In three patients, component revision was needed: two because of an infection and one because of a mechanical failure. After a mean follow-up of 9.6 years (2-20), 94% of the patients rated their result as either excellent or good. At time of follow-up, the Knee Society Score averaged 73.3 points (range, 29-100) and showed a significant gain (p < 0.001) compared to preoperative. Flexion contracture could be reduced significantly (p < 0.001) from 18.1° preoperatively to 8.4° at follow-up, whereas flexion remained unchanged. When infection or any component replacement was set as endpoints, the 10 years prosthetic survival was 90 and 86%, respectively. Total knee arthroplasty in haemophilic patients is a reliable treatment that results in pain relief and functional improvement with a low risk of postoperative infection. However, neither the postoperative infection rate nor the functional result does reach the same level as in a population not affected by haemophilia. IV.

Total Knee Arthroplasty in HIV-positive Haemophilic Knee Arthropathy Patients

Total Knee Arthroplasty in HIV-positive Haemophilic Knee Arthropathy Patients

The role of physiotherapy after total knee arthroplasty in patients with haemophilia

With the availability of clotting factor concentrates, advances in surgical techniques, better implant design, and improvements in postoperative management, total knee arthroplasty has become the treatment of choice for haemophilia patients suffering from end-stage haemophilic knee arthropathy. The success of this surgery is also dependent on close collaborations among the orthopaedic surgeon, the haematologist and the physiotherapist. Although haemophilic patients undergoing this surgery would likely benefit from a targeted rehabilitation programme, its specificities, modalities and limitations have thus far not been extensively studied. Employing the published data of rehabilitation after knee prosthesis in patients with osteoarthritis and haemophilic arthropathy along with clinical experience, the authors present a comprehensive and original review of the role of physiotherapy for patients with haemophilia undergoing knee arthroplasty.

Total knee arthroplasty for severe haemophilic arthropathy: long‐term experience in Taiwan

A number of articles have investigated the outcomes of total knee arthroplasty (TKA) and causes of prosthetic failure in patients with haemophilic arthropathy. The aims of this retrospective study were to evaluate the clinical and functional outcomes of TKA and causes of prosthetic failure in patients with haemophilic arthropathy. A consecutive series of 35 TKA in 26 patients with haemophilic arthropathy were performed between November 1985 and October 2006 by one experienced surgeon. The mean age at index operation was 34.2 years old (range: 23.4-47 years) and the mean follow-up duration was 82.2 months (range: 12-218 months). Clinical assessment included range of flexion, range of extension and total range of motion (ROM). Functional evaluation comprised pain score and functional score by Dr. Insall's Knee Society Clinical Rating System. The average preoperative ROM was 63.2 degrees with flexion contracture 15 degrees , whereas the average postoperative ROM was 79.8 degrees with flexion contracture 5.5 degrees . Improvement of range of flexion was 7.1 degrees (P = 0.16); improvement of range of extension was 9.5 degrees (P < 0.01). Average increase of total ROM was 16.6 degrees (P = 0.02). Pain score by Knee Society was 7.1 points preoperatively and 48 points postoperatively (P < 0.01); functional score by Knee Society was 42 points preoperatively and 77.1 points postoperatively (P < 0.01). Three patients received manipulations because of an inadequate ROM. Three infection episodes were treated with debridement and one of them received arthrodesis after removal of prosthesis. Two patients received revision TKA. One of them was because of loosening of femoral component. The other one received revision TKA because of insert wear. Though improvement in range of flexion is insignificant in haemophilic arthropathy of knee after TKA, it showed significant increase in total ROM after operation, especially in improvement of flexion contracture. It also showed great pain relief and significant functional gain. Under the circumstance of acceptable infection rate and complication, TKA is an effective method to achieve pain relief and gain better function in patients with haemophilic arthropathy of knee. The data of this study confirm those previously published by many authors.

Haemophilic knee arthropathy with extension contracture

Haemophilic knee arthropathy with extension contracture