Special Features of Total Knee Replacement in Hemophilia

Emerito Carlos Rodriguez-Merchan

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

Preoperative, Perioperative & Postoperative Physiotherapy & Rehabilitation Program

With the availability of clotting factor concentrates, advances in surgical techniques, better implant design and improvements in postoperative management, TKR has become the treatment of choice for hemophilia patients suffering from end-stage hemophilic knee arthropathy. Although hemophilic patients undergoing this surgery would likely benefit from a targeted rehabilitation program, its specificities, modalities and limitations have thus far not been extensively studied. Employing the published data of rehabilitation after TKR in patients with OA and hemophilic arthropathy along with clinical experience, some authors have presented comprehensive reviews of the role of physiotherapy for patients with hemophilia undergoing TKR.^[5,25]

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

Next Section

Abstract and Introduction
Arthroscopic Debridement of the Knee Prior to TKR
Perioperative Infusion of Replacement Clotting Factor
General Anesthesia
Thromboembolic Prophylaxis
Patellar Prosthetic Component
Antibiotic-loaded Cement
Prosthetic Lifespan
Muscular Atrophy, Axial Deformities & Risk of Prosthetic Instability
High Risk of Prosthetic Infection
Increased Risk of Bleeding
Preoperative, Perioperative & Postoperative Physiotherapy & Rehabilitation Program
Expert Commentary
Five-year View
References
Sidebar

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