Santos Silva Marta, Rodrigues-Pinto Ricardo, Rodrigues Cláudia, Morais Sara, Costa E Castro José
1 Department of Orthopaedics, Centro Hospitalar do Porto - Hospital de Santo António, Porto, Portugal.
2 ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019834337. doi: 10.1177/2309499019834337.
Knee arthropathy is a frequent complication affecting hemophilic patients, which can cause severe pain and disability. When conservative measures fail, total knee arthroplasty (TKA) may be performed.
Eighteen TKA were performed in 15 patients with hemophilia during a 24-year period in a Hemophilia Comprehensive Care Center. All patients were evaluated by a multidisciplinary team constituted by a hematologist, an orthopedic surgeon, and a physical medicine and rehabilitation physician. Mean follow-up was 11.3 years.
Ten-year survival rate with prosthesis removal as end point was 94.3%. At last, follow-up visual analog pain scale score was 3.2 points, knee osteoarthritis outcome scale was 86.7 points, and mean range of motion was 88°. Only two patients required perioperative transfusion. Complication rate was 27.8% and included two infections, two prosthesis stiffness, and one case of recurrent hemarthrosis.
After appropriate medical optimization and with prompt rehabilitation, TKA can be performed in hemophilic patients with good clinical results and survivor rates comparable to nonhemophilic patients.
膝关节病是血友病患者常见的并发症，可导致严重疼痛和残疾。保守治疗无效时，可进行全膝关节置换术（TKA）。
在一家血友病综合治疗中心，15例血友病患者在24年期间接受了18次TKA手术。所有患者均由血液科医生、骨科医生和物理医学与康复医生组成的多学科团队进行评估。平均随访时间为11.3年。
以取出假体为终点的10年生存率为94.3%。末次随访时，视觉模拟疼痛量表评分为3.2分，膝关节骨关节炎疗效评分为86.7分，平均活动范围为88°。仅2例患者需要围手术期输血。并发症发生率为27.8%，包括2例感染、2例假体僵硬和1例复发性关节积血。
经过适当的医学优化和及时康复，血友病患者可进行TKA手术，临床效果良好，生存率与非血友病患者相当。
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