High Risk of Prosthetic Infection
In hemophilia, the average rate of prosthetic infection after a TKR is 6–7%, whereas that for OA is 1–2%. Infection in patients with hemophilia and HIV may increase due to persistent intravenous access for infusing clotting factor and questionable preparation in many cases. However, this fact is very controversial. Moreover, many hemophilia patients are no longer HIV positive. Prosthetic infection could also be caused by the replacement clotting factor level not being 100% during the first 2 weeks of the postoperative stage, which would increase the risk of minor hemarthroses. It must not be forgotten that blood is an excellent culture medium for bacteria. In case of prosthetic infection of the knee, a prosthetic revision will have to be performed in one or two stages (Figure 4). Finally, when operating on these patients, the surgical team runs the risk of infection if they accidentally prick themselves, not only with HIV but also with the hepatitis C virus (in coinfected patients). Box 1 & Box 2 summarize risk factors of infection following TKR in general population and in person with hemophilia, respectively.
Infected total knee replacement in a young adult hemophilia patient that required a two-stage prosthetic revision. In the first stage, the prosthesis was removed and an antibiotic-loaded prefabricated articulated spacer was inserted. In the second stage, the spacer was removed and a constrained (rotating hinge) prosthesis was implanted: anteroposterior image of the infected TKR, which shows clear septic loosening of the prosthetic components. (A) Anteroposterior image of the spacer implanted in the first stage of the prosthetic revision in the same patient (B), and anteroposterior image of the implanted rotating hinge prosthesis (C).
Expert Rev Hematol. 2013;6(6):637-642. © 2013 Expert Reviews Ltd.