Special Features of Total Knee Replacement in Hemophilia

Emerito Carlos Rodriguez-Merchan

Expert Rev Hematol. 2013;6(6):637-642.

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.^[8] 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.

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Next Section

Table 1. Prosthetic lifespan in hemophiliac patients (percentage of primary total knee replacement removal-free survival).
Study (year)	Percentage of TKR removal-free survival	Ref.
Solimeno et al. (2009)	81 at 7 years	[20]
Cohen et al. (2000)	88.4 at 10 years	[21]
Sikkema et al. (2011)	94 at 20 years	[22]

TKR: Total knee replacement.

Box 1. Risk factors of infection following total knee replacement in general population.
Patient-related risk factors (immunosuppression treatment and previous infections in the knee) Lack of systematic preoperative screening by swab (nose and any skin lesion(s) during the month preceding surgery, recent history of surgery) Inadequate preoperative antibiotic prophylaxis Inappropriate surgeon's preparation and unclean air in the operating room. Inadequate skin preparation and dressings Intravenous therapy