Mortazavi S M J, Haghpanah B, Ebrahiminasab M M, Baghdadi T, Hantooshzadeh R, Toogeh G
Investigation was performed in Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Ministry of Health and Medical Education, Office of Organ Transplantation and Special Diseases, Tehran, Iran.
Haemophilia. 2016 Mar;22(2):303-307. doi: 10.1111/hae.12832. Epub 2015 Nov 4.
Haemophilic arthropathy of the knee is usually a bilateral affliction. The patients usually refer for treatment in young ages and do not have major comorbidities, being fit for bilateral simultaneous total knee arthroplasty.
In this study, we assessed the safety and cost-effectiveness of simultaneous bilateral surgery in patients with haemophilia.
Between April 2010 and April 2012, eight patients (16 knees) underwent bilateral simultaneous and 19 patients (19 knees) underwent unilateral total knee arthroplasty (TKA) at our institution. We compared the range of motion and flexion contracture, KSS, WOMAC knee score and SF36 quality of life score between two groups. The duration of hospital stay, coagulation factor consumption and all inpatient costs were recorded. The average follow-up was 26 and 29 months in unilateral and bilateral groups respectively.
At the conclusion of the study, the KSS and WOMAC and SF36 scores were not significantly different between the two groups. Mean ROM and flexion contracture did not differ significantly. The mean length of hospital stay was 15 days for bilateral patients and 12 days for unilateral patients, the difference being non-significant. None of our patients needed transfusion in any group. The cost of simultaneous bilateral TKA was about half of the expenses of staged bilateral TKA.
Simultaneous bilateral TKA seems to be a safe and cost-effective approach without increasing the rate of complications in patients' bilateral haemophilic knee arthropathy. The procedure is, at least, as effective as staged unilateral knee arthroplasty in improving the patients' quality of life.
膝关节血友病性关节病通常为双侧病变。患者通常在年轻时就医，且无重大合并症，适合双侧同时进行全膝关节置换术。
在本研究中，我们评估了血友病患者同期双侧手术的安全性和成本效益。
2010年4月至2012年4月期间，8例患者（16膝）在我院接受了双侧同期全膝关节置换术，19例患者（19膝）接受了单侧全膝关节置换术（TKA）。我们比较了两组之间的活动范围、屈曲挛缩、膝关节协会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）膝关节评分以及36项简短健康调查（SF36）生活质量评分。记录住院时间、凝血因子消耗量和所有住院费用。单侧组和双侧组的平均随访时间分别为26个月和29个月。
在研究结束时，两组之间的KSS、WOMAC和SF36评分无显著差异。平均活动范围和屈曲挛缩无显著差异。双侧患者的平均住院时间为15天，单侧患者为12天，差异无统计学意义。两组患者均无需输血。同期双侧TKA的费用约为分期双侧TKA费用的一半。
同期双侧TKA似乎是一种安全且具有成本效益的方法，不会增加双侧血友病性膝关节炎患者的并发症发生率。该手术在改善患者生活质量方面至少与分期单侧膝关节置换术同样有效。
