Department of Orthopedics, The First Affiliated Hospital of Zhejiang Traditional Chinese Medicine University, Hangzhou, China.
Medicine (Baltimore). 2022 Jul 8;101(27):e29667. doi: 10.1097/MD.0000000000029667.
Total hip arthroplasty (THA) has been an effective tool of advanced hemophiliac hip arthritis. There are only limited data of bilateral synchronous THA for end-stage arthropathy in hemophilia A patients. The aim of this retrospective study was to analyze clinical outcome and complication rate of bilateral THA for hemophilia A patients with end-stage arthropathy of hip and review the operative strategy. From August 2012 to July 2016, 48 hips of 24 patients with hemophilia A patients underwent THA by a single experienced chief orthopedic surgeon. Clinical and radiological evaluations were included of operation time, blood loss, the quantity of blood transfusion, clotting factor consumption, duration of hospitalization, modified Harris hip score, complication rate, and radiographic assessment. All the 24 patients successfully completed the operation, followed up for 5 to 8 years, and the mean time was 6.5 years. The average operation time was 140 minutes (range, 120-180 minutes). The average total blood loss was 225 mL (range, 150-400 mL). The mean red blood cell transfusion amount was 2.4 U (range, 0-6 U). the mean hospitalization time was 24 days (range, 16-46 days). The mean amount of clotting factor VIII used in the perioperative period for management of hemophilia A was 30,600 U (range, 18,000-52,000 U). Average modified Harris hip score increased from 46.6 (range 28-70) points preoperatively to 90.2 (range 75-98) points at final follow-up, complications were few. With excellent operative techniques and hematological management, bilateral synchronous THA for end-stage arthropathy in hemophilia A patients can provide satisfactory outcomes.
全髋关节置换术 (THA) 是治疗血友病性髋关节关节炎的有效手段。目前仅有有限的关于血友病 A 患者终末期髋关节病变行双侧同步 THA 的数据。本回顾性研究旨在分析血友病 A 患者终末期髋关节病变行双侧 THA 的临床结果和并发症发生率，并回顾手术策略。自 2012 年 8 月至 2016 年 7 月，由一位经验丰富的骨科主任医生对 24 例血友病 A 患者的 48 髋进行 THA。纳入的临床和影像学评估包括手术时间、失血量、输血量、凝血因子消耗、住院时间、改良 Harris 髋关节评分、并发症发生率和影像学评估。所有 24 例患者均顺利完成手术，随访 5 至 8 年，平均随访时间为 6.5 年。平均手术时间为 140 分钟（范围 120-180 分钟）。平均总失血量为 225 mL（范围 150-400 mL）。平均红细胞输注量为 2.4 U（范围 0-6 U）。平均住院时间为 24 天（范围 16-46 天）。围手术期管理血友病 A 所需的平均凝血因子 VIII 使用量为 30600 U（范围 18000-52000 U）。改良 Harris 髋关节评分由术前的 46.6（范围 28-70）分增加至末次随访时的 90.2（范围 75-98）分，并发症较少。采用精湛的手术技术和血液学管理，双侧同步 THA 治疗血友病 A 患者的终末期髋关节病变可获得满意的结果。
