Special Features of Total Knee Replacement in Hemophilia

Emerito Carlos Rodriguez-Merchan

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

Five-year View

My speculative view is that in 5 years time, better knee prosthetic designs and better hemostasis control will allow us diminish the rate of complications following TKR in hemophiliac patients (mainly the rate of infections). The hypothetical reason for this is that better hemostasis will diminish the risk of clinical and subclinical bleeds during the postoperative period. In hemophiliac patients who are HIV positive, this is not the case. In addition to that, the prosthetic lifespan in persons with hemophilia will gradually increase.

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