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Review
. 2016 Jun 18;7(6):370-5.
doi: 10.5312/wjo.v7.i6.370.

Orthopedic disorders of the knee in hemophilia: A current concept review

E Carlos Rodriguez-Merchan  1 , Leonard A Valentino  1
Affiliations
Review

Orthopedic disorders of the knee in hemophilia: A current concept review

E Carlos Rodriguez-Merchan et al. World J Orthop. .

Abstract

The knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy (HA) in patients with deficiency of coagulation factor VIII or IX and thus this manuscript seeks to present a current perspective of the role of the orthopedic surgeon in the management of these problems. Lifelong factor replacement therapy (FRT) is optimal to prevent HA, however adherence to this regerous treatment is challenging leading to breakthrough bleeding. In patients with chronic hemophilic synovitis, the prelude to HA, radiosynovectomy (RS) is the optimal to ameliorate bleeding. Surgery in people with hemophilia (PWH) is associated with a high risk of bleeding and infection, and must be performed with FRT. A coordinated effort including orthopedic surgeons, hematologists, physical medicine and rehabilitation physicians, physiotherapists and other team members is key to optimal outcomes. Ideally, orthopedic procedures should be performed in specialized hospitals with experienced teams. Until we are able to prevent orthopedic problems of the knee in PWH will have to continue performing orthopedic procedures (arthrocentesis, RS, arthroscopic synovectomy, hamstring release, arthroscopic debridement, alignment osteotomy, and total knee arthroplasty). By using the aforementioned procedures, the quality of life of PWH will be improved.

Keywords: Hemophilia; Knee; Orthopedic problems; Prevention; Surgical treatment.

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Figures

Figure 1
Figure 1
Severe bilateral hemophilic arthropathy of the knee in a 37-year-old male.
Figure 2
Figure 2
Flow chart of our search strategy.
Figure 3
Figure 3
Severe painful hemophilic arthropathy of the left knee in a 41-year-old male. A cemented total knee arthroplasty (NexGen, Zimmer, United States) was performed with a satisfactory result: A: Anteroposterior preoperative radiograph; B: Lateral preoperative view; C: Anteroposterior radiograph 5 years later; D: Lateral view at 5 years. The quality of life of this patient improved significantly.
See this image and copyright information in PMC

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