Increased Risk of Bleeding
If the clotting factor level is not sufficient (ideally 100% for 2 weeks), the risk of postoperative bleeding will increase. Chevalier et al. have reported a rate of postoperative hematomas of 36% and a rate of postoperative hemathroses of 3%. On the other hand, even if the hemostasis is correct, an arterial pseudoaneurysm may be formed. Therefore, if after a TKR, the hemophilia patient presents a hemarthrosis in the immediate postoperative period, the possible existence of a pseudoaneurysm will have to be ruled out. After draining the hemarthrosis by arthrocentesis (joint aspiration), a CT angiography and/or an arteriogram, which may confirm the existence of the pseudoaneurysm, must be performed as soon as possible.[23,24] Normally, performing an arterial embolization will resolve the problem. Otherwise, a vascular operation performed as open surgery will be required.
Expert Rev Hematol. 2013;6(6):637-642. © 2013 Expert Reviews Ltd.