Special Features of Total Knee Replacement in Hemophilia

Emerito Carlos Rodriguez-Merchan

Disclosures

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

In This Article

Expert Commentary

TKR is an operation frequently needed in hemophiliac patients and it improves the quality of life of patients suffering from painful and/or disabling arthropathy. This procedure, however, carries a higher risk of bleeding and infection among hemophiliacs than it does for other patients. It is therefore advisable to implant prosthetic components using antibiotic-loaded cement. The degree of constriction of the prosthesis to be implanted will depend on whether or not there are serious prior axial deformities and the degree of muscular atrophy present in the patient. It is essential to maintain a level of 100% of the replacement clotting factor for 2 weeks. It is preferable to use general anesthesia when performing this operation, to prevent the risk of spinal bleeding.

Prosthetic lifespan actually tends to match those of patients without hemophilia provided that adequate hemostatic precautions are taken over the initial perioperative and postoperative period. Infection is potentially the biggest problem in patients with hemophilia. This could be attributed to their coinfection status; however, this is becoming less of a problem and patients are being better managed, particularly with regard to HIV.

Current controversies on TKR in hemophiliacs that require further research are the type of anesthesia (general or epidural), and the use of intra-articular tranexamic acid just after finishing the procedure in order to diminish the amount of blood loss.

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