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Case Reports
. 2025 Apr 25;26(1):417.
doi: 10.1186/s12891-025-08611-1.

Bilateral total knee replacement for hemophilic arthropathy: a case report

Mahmoud A Hafez  1 , Mohamed Talaat  2 , Ahmad Yaman Kebbe  3   4 , Abdelrahman Helmy  3 , Abdelrahman M Makram  3   5
Affiliations
Case Reports

Bilateral total knee replacement for hemophilic arthropathy: a case report

Mahmoud A Hafez et al. BMC Musculoskelet Disord. .

Abstract

Von Willebrand disease (vWD) and hemophilia present unique challenges in orthopedic surgery due to their inherent bleeding risks and potential complications. While joint bleedings are well-documented in hemophilia, they are less understood in vWD, especially regarding their impact on daily activities and the development of arthropathy. We present a case of a young female patient aged 25 years with vWD Type 3 who underwent bilateral total knee replacement (TKR) due to end-stage knee osteoarthritis. Following two previous operations of the right knee at the age of 14, the patient had high degree of extra-articular valgus and intra-articular deformity, ankylosed knee in 30o flexion, osteopenia, and chronic patellar dislocation. Bilateral TKR was performed using patient-specific templating (PST) technology, which includes preoperative planning using a CT scan followed by surgical execution. Financial constraints and limited prosthetic resources necessitated a sequential approach to TKR, addressing the more affected right knee first. Despite many challenges, successful outcomes were achieved, with significant improvements in pain, mobility, overall satisfaction, and no complications at two-year follow-up. Our case highlights the importance of individualized treatment strategies, meticulous surgical planning, and postoperative care in managing knee arthropathy patients with bleeding disorders.

Keywords: Fused knee arthroplasty; Patient-specific templating; Total knee replacement; Valgus deformity; Von Willebrand disease.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Ethical Committee of October 6 University Hospital. Consent for publication: The involved patient signed a written consent form for the publication of her personal and clinical data as well as her radiographic images. Competing interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. Consent to participate: The involved patient signed a written informed consent.

Figures

Fig. 1
Fig. 1
a) Preoperative images displaying an x-ray featuring the anterior-posterior (AP) view of both knees, illustrating on the right knee the extra-articular valgus deformity, severe osteopenia, and lateral patellar dislocation (orange arrow) b) Preoperative images displaying an x-ray showing lateral view of both knees. The right patella is not located anteriorly and not seen in this view
Fig. 2
Fig. 2
Postoperative antero-posterior (A) and lateral (B) x-rays of the right knee
Fig. 3
Fig. 3
Postoperative antero-posterior (A) and lateral (B) x-rays of the left knee
See this image and copyright information in PMC

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