EXPERIENCE OF JOINT REPLACEMENT IN THE MANAGEMENT OF HAEMOPHILIC ARTHROPATHY
V. Yu. Zorenko,
T. Yu. Polyanskaya,
E. E. Karpov,
N. V. Sadykova,
D. V. Vasiliev,
G. V. Mishin,
M. S. Sampiev,
A. V. Golobokov,
D. Yu. Petrovsky https://doi.org/10.18821/0234-5730-2017-62-2-70-74
Abstract
We report our experience of 675 (616 primary, 59 revision) joint replacements in 425 patients performed in one hospital. There were 383 patients with hemophilia A and 42 patients with hemophilia B (age from 18 to 76 years). Inhibitor was detected in 18 hemophilia patients. 90% of patients had positive antibodies to hepatitis C (anti-HCV+), 3 patients had HIV infection. There were 552 knee, 115 hip, 5 shoulder and 3 elbow replacements. 23 knee and 3 hip replacements were performed in hemophilia patients with inhibitor. The average follow-up of implants was 6 years (from 4 months to 20 years). There were revision replacements in 8.8% of cases: 5.5% patients with aseptic loosening and 3% patients – with deep infections. In hemophilia patients deep infection occurred much more frequent – 11%. The significantly higher rate of complications (11%) was observed in patients with inhibitors. In spite of elevated risks for the development of complications in hemophilia patients joint replacement is the only effective procedure in the treatment of end-stage arthropathy. Hemophilia patients need an individualized approach in providing hemostasis and prophylactic antibacterial therapy.
About the Authors
V. Yu. Zorenko
National Research Center for Hematology
Russian Federation
Moscow, 125167
Russian Federation
Moscow, 125167
T. Yu. Polyanskaya
National Research Center for Hematology
Russian Federation
Russian Federation
Moscow, 125167
Polyanskaya Tatyana Yu., MD, PhD, senior researcher, traumatologist-orthopaedic surgeon, orthopedic department for hemophilia patients
E. E. Karpov
National Research Center for Hematology
Russian Federation
Moscow, 125167
Russian Federation
Moscow, 125167
N. V. Sadykova
National Research Center for Hematology
Russian Federation
Moscow, 125167
Russian Federation
Moscow, 125167
D. V. Vasiliev
National Research Center for Hematology
Russian Federation
Moscow, 125167
Russian Federation
Moscow, 125167
G. V. Mishin
National Research Center for Hematology
Russian Federation
Moscow, 125167
Russian Federation
Moscow, 125167
M. S. Sampiev
National Research Center for Hematology
Russian Federation
Moscow, 125167
Russian Federation
Moscow, 125167
A. V. Golobokov
National Research Center for Hematology
Russian Federation
Moscow, 125167
Russian Federation
Moscow, 125167
D. Yu. Petrovsky
National Research Center for Hematology
Russian Federation
Russian Federation
Moscow, 125167
References
1. Andreev Yu.N. The many faces of hemophilia. Moscow: Nyudiamed; 2006.
2. Stein H., Duthie R.B. The pathogenesis of chronic haemophilic arthropathy. J. Bone Joint Surg. Br. 1981; 63B(4): 601–9.
3. Roosendaal G., Lafeber F.P. Pathogenesis of haemophilic arthropathy. Haemophilia. 2006; 12(Suppl. 3): 117–21.
4. Van Creveld S., Hoedemaker P.J., Kingma M.J., Wagenvoort,C.A. Degenerations of joints in haemophiliacs under treatment by modern methods. J. Bone Joint Surg. Br. 1971; 53(2): 296–302.
5. Madhok R., Bennett D., Sturrock R.D., Forbes C.D. Mechanisms of joint damage in an experimental model of haemophilic arthritis. Arthritis Rheum. 1988; 31(3): 1148–55.
6. Wood K., Omar A., Shaw M.T. Haemophilic arthropathy. A combined radiological and clinical study. Br. J. Radiol. 1969; 42(499): 498–505.
7. Funk M.B., Schmidt H., Becker S., Escuriola C., Klarmann D., Klingebiel T., Kreuz W. Modified magnetic resonance imaging score compared with orthopaedic and radiological scores for the evaluation of haemophilic arthropathy. Haemophilia. 2002; 8(2): 98–103.
8. Luck J.V. Jr., Kasper C.K. Surgical management of advanced hemophilic arthropathy. An overview of 20 years experience. Clin. Orthop. Relat. Res. 1989; (242): 60–82.
9. Unger A.S., Kessler C.M., Lewis R.J. Total knee arthroplasty in human immunodeficiency virus-infected hemophiliacs. J. Arthroplasty. 1995; 10(4): 448–52.
10. Fischer K., van der Bom J.G., Mauser-Bunschoten E.P., Roosendaal G., Prejs R., Grobbee D.E., van den Berg H.M. Changes in treatment strategies for severe haemophilia over the last 3 decades: effects on clotting factor consumption and arthropathy. Haemophilia. 2001; 7(5): 446–52.
11. Nilsson I.M., Berntorp E., Lofqvist T., Pettersson H. Twenty-five years’ experience of prophylactic treatment in severe haemophilia A and B. J. Intern. Med. 1992; 232(1): 25–32.
12. Pettersson H., Nilsson I.M., Hedner U., Norehn K., Ahlberg A. Radiologic evaluation of prophylaxis in severe haemophilia. Acta Paediatr. Scand. 1981; 70(4): 565–70.
13. Zorenko V.Yu., Khorobrykh L.S., Polyanskaya T.Yu., Karpov E.E., Sadykova N.V. Knee arthroplasty in patients with hemophilia. Problems of Hematology and Blood Transfusion. Russian Journal (Problemy gematologii i perelivaniya krovi). 2006; 2: 58–60.
14. Polyanskaya T.Yu., Zorenko V.Yu. Modern aspects of surgical treatment of the musculoskeletal system in patients with hemophilia. Hematology and Transfusiology. Russian Journal (Gematologiya i transfusiologiya). 2008; 53(5): 24–6.
15. Post M., Telfer M. Surgery in hemophilic patients. J. Bone Joint Surg. Am. 1975; 57(8): 1136–45.
16. Marmor L. Total knee replacement in haemophilia. Clin. Orthop. Relat. Res. 1977; (125): 192–5.
17. McCollough NC.., Enis J.E., Lovitt J., Lian E.C., Niemann K.N., Loughlin E.C. Synovectomy or total replacement of the knee in haemophilia. J. Bone Joint Surg. Am. 1979; 61(1): 69–75.
18. Pettersson H., Ahlberg A., Nilsson I.M. A radiologic classification of haemophilic arthropathy. Clin. Orthop. Relat. Res. 1980; (149): 153–9.
19. Chiang C.C., Chen P.Q., Shen M.C., Tsai W. Total knee arthroplasty for severe haemophilic arthropathy: long-term experience in Taiwan. Haemophilia. 2008; 14(4): 828–34.
20. Massin P., Lautridou C., Cappelli M., et al. Total knee arthroplasty with limitations of flexion. Orthop. Traumatol. Surg. Res. 2009; 95(4, Suppl. 1): S1–6.
21. Solimeno L.P., Mancuso M.E., Pasta G., Santagostino E., Perfetto S., Mannucci P.M. Factors influencing the long-term outcome of primary total knee replacement in haemophiliacs: a review of 116 procedures at a single institution. Br. J. Haematol. 2009; 145(2): 227–34.
22. Goddard N.J., Mann H.A., Lee C.A. Total knee replacement in patients with end-stage haemophilic arthropathy: 25-year results. J. Bone Joint Surg. Br. 2010; 92(8): 1085–9.
23. Rodriguez-Merchan E. C., Gomez-Cardero P., Jimenez-Yuste V. Infection after total knee arthroplasty in haemophilic arthropathy with special emphasis on late infection. Haemophilia. 2011; 17(5): 831–2.
24. Wang K., Street A., Dowrick A., Liew S.Clinical outcomes and patient satisfaction following total joint replacement in haemophilia – 23-year experience in knees, hips and elbows. Haemophilia. 2012; 18(1): 86–93.
25. Bengtson S., Knutson K. The infected knee arthroplasty. A 6-year followup of 357 cases. Acta Orthop. Scand. 1991; 62(4): 301–11.
26. Blom A.W., Brown J., Taylor A.H., Pattison G., Whitehouse S., Bannister G.C. Infection after total knee arthroplasty. J. Bone Joint Surg. Br. 2004; 86(5): 688–91.
27. Peersman G., Laskin R., Davis J., Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin. Orthop. Relat. Res. 2001; (392): 15–23.
Review
For citations:
Zorenko V.Yu., Polyanskaya T.Yu., Karpov E.E., Sadykova N.V., Vasiliev D.V., Mishin G.V., Sampiev M.S., Golobokov A.V., Petrovsky D.Yu. EXPERIENCE OF JOINT REPLACEMENT IN THE MANAGEMENT OF HAEMOPHILIC ARTHROPATHY. Russian journal of hematology and transfusiology. 2017;62(2):70-74. (In Russ.) https://doi.org/10.18821/0234-5730-2017-62-2-70-74
Views:
702
Email this article 
