Special Features of Total Knee Replacement in Hemophilia

Emerito Carlos Rodriguez-Merchan

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

Prosthetic Lifespan

It has been reported a removal-free survival of 81% at 7 years,^[20] 88.4% at 10 years^[21] and 94% at 20 years (Table 1).^[22] Although hemophilia patients who have had a TKR implant tend to be relatively young (mean age 35–45 years) in comparison with the group of patients with OA (mean aged 65–70 years), one publication states that prosthetic lifespan is greater in hemophilia patients than in patients with OA.^[22] If the available evidence, however, is analyzed as a whole, it is likely to conclude that the lifespan of prosthetic knee implants in hemophilic patients is shorter because of the increased risk of infection, due to the fact that many hemophiliac patients are HIV positive. However, larger comparative series would be required in order to confirm this assertion.

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