Department of Orthopaedic Surgery, St. James's Hospital, Dublin, Ireland.
Department of Orthopaedic Surgery, Cork University Hospital, Cork, Ireland.
J Arthroplasty. 2022 Mar;37(3):581-592.e1. doi: 10.1016/j.arth.2021.10.015. Epub 2021 Oct 28.
Patients with hemophilia (PWHs) may experience spontaneous or traumatic bleeding episodes. Recurrent bleeding can lead to end-stage hemophilic arthropathy and total knee replacement (TKR) provides an effective treatment. The aim of this study is to investigate outcomes in PWHs who undergo TKR.
A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study outcomes included patient-reported functional outcomes, implant survivorship, and complications. Subgroup analysis was performed assessing the effect of recombinant prophylaxis medication by comparing studies that included only TKRs performed after the year 2000 (period A), to those that included TKRs before 2000 (period B).
Twenty-eight studies were included, with a total of 1210 TKRs performed in 917 PWHs. The mean age of patients was 38.5 years (standard deviation 5.1) with a mean length of follow-up of 7.1 years (standard deviation 2.9). The total complication rate was 28.7%, with 19.3% requiring a further procedure. Hospital for Special Surgery Knee Score improved by 44.6 points (confidence interval 38.9-50.4) and Knee Society Score function improved by 35.9 points (confidence interval 30.1-41.8). Total range of motion improved by 22.3°. The most common complication was post-operative hemarthrosis (7.6%, 92 TKRs). Deep infection (6.2% vs 3.9%) and aseptic loosening (3.8% vs 2.1%) rates fell between period B and period A.
TKR in PWHs is a successful procedure improving function, reducing pain, and improving range of motion. PWHs undergo TKR at a younger age and have a higher risk of complications, though contemporary treatment has reduced these risks. PWHs can expect similar survivorship to the general population.
患有血友病（PWH）的患者可能会经历自发性或创伤性出血发作。反复出血可导致血友病终末期关节病和全膝关节置换术（TKR），为有效的治疗方法。本研究旨在调查接受 TKR 的 PWH 的结局。
根据系统评价和荟萃分析的首选报告项目进行了系统评价和荟萃分析。研究结果包括患者报告的功能结果、植入物存活率和并发症。通过比较仅包括 2000 年后进行的 TKR 的研究（A 期）与包括 2000 年前进行的 TKR 的研究（B 期），进行了亚组分析，以评估重组预防药物的效果。
纳入了 28 项研究，共纳入了 917 例 PWH 的 1210 例 TKR。患者的平均年龄为 38.5 岁（标准差为 5.1），平均随访时间为 7.1 年（标准差为 2.9）。总并发症发生率为 28.7%，19.3%需要进一步治疗。特种外科医院膝关节评分提高了 44.6 分（置信区间 38.9-50.4），膝关节协会评分功能提高了 35.9 分（置信区间 30.1-41.8）。总活动范围改善了 22.3°。最常见的并发症是术后关节积血（7.6%，92 例 TKR）。深部感染（6.2%比 3.9%）和无菌性松动（3.8%比 2.1%）的发生率在 B 期和 A 期之间下降。
TKR 是治疗 PWH 的一种成功方法，可改善功能、减轻疼痛和改善活动范围。PWH 接受 TKR 的年龄较小，并发症风险较高，但现代治疗已降低了这些风险。PWH 可预期与普通人群相似的存活率。
