Special Features of Total Knee Replacement in Hemophilia

Emerito Carlos Rodriguez-Merchan


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

In This Article

Arthroscopic Debridement of the Knee Prior to TKR

In younger patients (aged 40–50 years) and/or with a moderate-to-severe degree of arthropathy, we can try a debridement of the knee before deciding on a TKR implant. In the past, debridement was performed as open surgery, but today it is preferable to use arthroscopy (because of the lesser complications and better results this provides). The fundamental reason for considering debridement prior to the TKR is that the average lifespan of TKRs is 15 years.[7] After this period, a prosthetic revision is likely to be necessary (removal of the initial prosthesis and replacement with a new one). This prosthetic revision surgery becomes more complex and carries a greater risk of complications the more times it is repeated. Through arthroscopic debridement, we may delay the need for a TKR for several years, although results are both variable and inconsistent. If a patient has marked axial deformity of the knee (varus or valgus), debridement is contraindicated. In such a case, we would have to think about performing an alignment osteotomy. The combination of these two procedures (debridement and osteotomy) is rarely used in the case of hemophiliac patients.