Low infection, high function rates following TKR in hemophilic patients

Researchers observed a 94% implant survival rate and improved ROM at 9 years' mean follow-up.

GLASGOW, Scotland â€” In the past, researchers have found varied results performing total knee replacement in patients with hemophilia, but results from a new study presented here suggest such patients can achieve good results.

Haroon A. Mann, MRCS, AFRCS, of the Royal Free and University College School of Medicine, London, and colleagues retrospectively reviewed the results of 60 TKRs performed in 43 patients with severe hemophilia. The patients had a mean age of 43.3 years at surgery (range, 25 to 70 years). Of the 60 arthroplasties in the study, 58 were performed on men.

At a mean 9 years' follow-up, the researchers found less than a 2% overall infection rate, and only four patients had experienced deep infection at final follow-up, said Mann, who presented the results at the 2006 Annual Congress of the British Orthopaedic Association.

Further, "We found 93% of our Hospital for Special Surgery functional scores were excellent or good, and ... we had 94% [implant] survival at 20 years," he said.

Patients also had a statistically significant improvement in range of motion, he noted.

Mann cautioned that both preoperative and postoperative physical therapy and rehabilitation are imperative for successful TKR results in hemophilic patients.

"These are young individuals at the prime of their life with significant destruction and disability," Mann said. "Successful results ... can be achieved in this patient subgroup, [with] the major objective of surgery being to reduce pain."

For more information:
Mann HA, Goddard NJ, Choudhury Z, et al. Primary total knee replacement surgery in patients with severe haemophilia - Long-term results. Presented at the 2006 Annual Congress of the British Orthopaedic Association. Sept. 27-29, 2006. Glasgow, Scotland.