Haemophilic arthropathy: long-term outcomes in 107 primary total knee arthroplasties.

BACKGROUND

Arthropathy of the knee is a frequent complication in patients with severe bleeding disorders leading to considerable pain and disability. Total knee arthroplasty (TKA) provides marked pain relief. However, a modest functional outcome and a high number of complications due to prosthetic infection and loosening are reported. Data on long-term outcomes are scarce, and most case series include few patients. We have studied clinical outcomes and complications of TKAs with special emphasis on prosthetic survival and periprosthetic infection.

METHODS

A consecutive series of 107 TKAs in 74 patients with haemophilic arthropathy were retrospectively reviewed. Follow-up was mean 11.2 years (range 0.8-33.1 years).

RESULTS

Five- and 10-year survival rates, with component removal for any reason as the end point, were 92% and 88%, respectively. Twenty-eight TKAs were removed after median 10 years (range 0.8-28 years). The most common cause of failure was aseptic loosening (14 knees) and periprosthetic infection (seven knees). The overall infection rate was 6.5%. The mean postoperative drop in haemoglobin levels was 4.3 g/dL (range 0.5-9.4) with a significant difference between haemophilia A patients with and without inhibitor (6.3 g/dL (range 3.6-9.4) versus 3.7 g/dL (range 0.5-8.1) (p<0.001). A painless knee was reported in 93% of the TKAs at the latest follow-up.

CONCLUSIONS

The medium and long-term results of primary TKA in a large haemophilic population show good prosthetic survival at five and 10 years with an excellent relief of pain. Periprosthetic infection is still a major concern compared to the non-haemophilic population.

LEVEL OF EVIDENCE

Level IV.