Ahmed H Shafeeq, Jayaram Purva Reddy
Bangalore Medical College and Research Institute, Bangalore, India.
Anesth Pain Med (Seoul). 2024 Jul;19(3):194-208. doi: 10.17085/apm.24047. Epub 2024 Jul 23.
Managing hemophilia in patients undergoing joint replacement surgery requires a comprehensive approach encompassing preoperative assessment, meticulous intraoperative care, and tailored postoperative management. Evaluation of joint integrity, bleeding history, and inhibitor presence guides surgical planning and hemostatic therapy selection to optimize outcomes. During surgery, careful attention to factor replacement, antibiotic prophylaxis, anesthetic techniques, and orthopedic strategies minimizes bleeding risk and enhances surgical success. Postoperatively, effective pain management, continued hemostatic therapy, and individualized rehabilitation programs are vital for facilitating recovery and preventing complications. Close monitoring for potential complications, such as periprosthetic joint infection and recurrent hemarthrosis, allows for prompt intervention when necessary. Overall, a collaborative approach involving hematologists, orthopedic surgeons, anesthesiologists, and rehabilitation specialists ensures comprehensive care tailored to the unique needs of patients with hemophilia undergoing joint replacement surgery, ultimately optimizing outcomes and improving quality of life. This holistic approach addresses the multifaceted challenges posed by hemophilia and joint replacement surgery, providing patients with the best possible chance for successful outcomes and long-term joint function. By integrating specialized expertise from multiple disciplines and implementing evidence-based strategies, healthcare providers can effectively manage hemophilia in the context of joint replacement surgery, mitigating risks and maximizing benefits for patients.
对接受关节置换手术的血友病患者进行管理需要一种全面的方法，包括术前评估、细致的术中护理和量身定制的术后管理。对关节完整性、出血史和抑制物存在情况的评估指导手术规划和止血治疗选择，以优化治疗结果。在手术过程中，密切关注凝血因子替代、抗生素预防、麻醉技术和骨科策略可将出血风险降至最低，并提高手术成功率。术后，有效的疼痛管理、持续的止血治疗和个性化的康复计划对于促进康复和预防并发症至关重要。密切监测潜在并发症，如假体周围关节感染和复发性关节积血，以便在必要时及时进行干预。总体而言，血液科医生、骨科医生、麻醉医生和康复专家共同协作，确保为接受关节置换手术的血友病患者提供符合其独特需求的全面护理，最终优化治疗结果并提高生活质量。这种整体方法解决了血友病和关节置换手术带来的多方面挑战，为患者提供了获得成功治疗结果和长期关节功能的最佳机会。通过整合多学科的专业知识并实施循证策略，医疗服务提供者可以在关节置换手术中有效管理血友病，降低风险并为患者最大化获益。
