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Case Reports
. 2017 Jan 9:23:129-137.
doi: 10.12659/msm.899580.

Revision Knee Arthroplasty in Patients with Inherited Bleeding Disorders: A Single-Center Experience

Andrzej Kotela  1   2 , Magdalena Wilk-Frańczuk  3 , Piotr Żbikowski  2 , Paweł Łęgosz  1 , Paweł Ambroziak  2 , Ireneusz Kotela  2   4
Affiliations
Case Reports

Revision Knee Arthroplasty in Patients with Inherited Bleeding Disorders: A Single-Center Experience

Andrzej Kotela et al. Med Sci Monit. .

Abstract

BACKGROUND The results of total knee arthroplasty (TKA) in patients with inherited bleeding disorders (IBDs) are poorer when compared with those in the general population, with a notably higher risk of complications and higher revision rates. Thus, revision procedures are becoming a growing concern in this group of patients. The aim of this study was to evaluate the results of revision TKA in patients with IBD. MATERIAL AND METHODS A retrospective cohort study with longitudinal assessment of hemophilia patients scheduled for revision TKA between January 2010 and September 2015 was performed. The clinical status of the patients was assessed based on the Knee Society Score, and the Numeric Rating Scale was used to assess knee pain severity and patient satisfaction with the surgery. Radiological examination, post-operative complications, and reinterventions were recorded and analyzed. RESULTS Very good results were obtained in all patients treated for aseptic loosening of the implant. However, inferior results were found in cases with infection. All patients operated on for aseptic loosening required only single-stage TKA, whereas patients with infection underwent multiple interventions. Complications were observed only in cases with infection. CONCLUSIONS Our study clearly outlined the differences in results based on failure mode, with far inferior results obtained in cases with infection. Given the lack of data in this area as well as the high specificity of this population, further high-quality studies are needed.

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Figures

Figure 1
Figure 1
Case 3: (A) antibiotic-loaded knee spacer (pre-operative view), (B) post-operative radiograph 2 years after the operation, and (C) implant migration (arrows).
Figure 2
Figure 2
Case 4: (A) pre-operative and (B) post-operative (3.5 years) radiographs.
Figure 3
Figure 3
Case 9: vast skin damage with necrotic tissue at the anterolateral knee region.
See this image and copyright information in PMC

References

    1. Cancienne JM, Werner BC, Browne JA. Complications after TKA in patients with hemophilia or von Willebrand’s disease. J Arthroplasty. 2015;30:2285–89. - PubMed
    1. Rodriguez-Merchan EC. Aspects of current management: orthopaedic surgery in haemophilia. Haemophilia. 2012;18:8–16. - PubMed
    1. World Federation of Hemophilia. WFH Guidelines for Management of Hemophilia. Montreal, Canada: Blackwell Publishing; 2005.
    1. Kotela A, Żbikowski P, Ambrozk P, Kotela I. The Hip: Preservation, Replacement, and Revision. Vol. 2. Brooklandville, MD: DTPC; 2015. Total hip arthroplasty in patients with bleeding disorders.
    1. Żbikowski P, Ambroziak P, Kotela A, Kotela I. Możliwości i perspektywy leczenia ortopedycznego zmian stawowych związanych z wrodzonym niedoborem czynników krzepnięcia. J Tranfusion Med. 2015;8:3–11. [in Polish]

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