Special Features of Total Knee Replacement in Hemophilia

Emerito Carlos Rodriguez-Merchan


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

In This Article

Perioperative Infusion of Replacement Clotting Factor

When performing a TKR on a hemophiliac patient, it is essential to achieve a high level of replacement clotting factor (factor VIII or factor IX), ideally of 100%, for 2 weeks.[8,9] The best way to achieve this is by continuous intravenous infusion of the deficient clotting factor although this is not always possible. The alternative is bolus infusion. In hemophiliac patients with inhibitor, the treatment is based on by-passing agents such as activated prothrombin complex concentrates (aPCCs) (FEIBA, Baxter) or recombinant factor VII activated (rFVIIa) (NovoSeven, NovoNordisk).[10–12] Adequate hemostasis is essential in order to avoid the complications that will be covered later in this article. Perfect coordination between the orthopedic surgeons and hematologists is essential.