Abstract:Objective To evaluate the safety and clinical efficacy of simultaneous bilateral knee arthroplasty (TKA) in the treatment of advanced hemophilia with knee arthritis.Methods From January 2008 to December 2017,10 cases (20 knees) of advanced hemophilia knee arthritis were diagnosed in our hospital and bilateral knee arthroplasty was performed in the same period,while 13 cases (13 knees) of advanced hemophilia arthritis were performed in the control group.All were male patients.The safety and clinical efficacy of the two groups were compared and analyzed.Results 23 patients (33 knees) were followed up for an average of (78.00±58.84)months.There was no significant difference between the two groups before surgery (P>0.05).The operative time,intraoperative blood loss,total blood transfusion volume,wound drainage volume,and postoperative hemoglobin and albumin decline were significantly higher in the simultaneous bilateral group than in the unilateral group (P<0.05).There was no significant difference in perioperative coagulation factor consumption,hospitalization cost (excluding prosthesis cost),and hospitalization time between the two groups (P>0.05).ROM,VAS score,HSS score and flexion contracture of knee joint were significantly improved in the two groups after operation of 4 weeks and the last follow-up (P<0.05).There were no significant differences in ROM,VAS score,HSS score,and flexion contracture between the two groups at 4 weeks after operation (P> 0.05).At the last follow-up,VAS score and flexural contracactures of the simultaneous bilateral group were lower than that of the unilateral group,HSS score and satisfaction were higher than that of the unilateral group,the difference was statistically significant (P<0.05),while the activity ROM was slightly higher than that of the unilateral group,but the difference was not statistically significant (P>0.05).Two patients with bilateral knee arthroplasty had joint hematoma,and one patient had incision bleeding and poor healing.There were no complications such as infection,loosening,thrombosis and death.Conclusion Simultaneous bilateral knee arthroplasty for advanced hemophilia and arthritis is a safe,economical and effective way to improve joint function.In the case of patient tolerance and strict perioperative comprehensive management,simultaneous bilateral knee arthroplasty is more conducive to rehabilitation.
[1]RodriguezMerchan EC,Valentino LA.Orthopedic disorders of the knee in hemophilia:A current concept review[J].World J Orthop,2016,7(6):370-375.
[2]Melchiorre D,Manetti M,MatucciCerinic M.Pathophysiology of hemophilic arthropathy[J].Clin Med,2017,6(7):63.
[3]Guodemar-Pérez J,Ruiz-López M,Rodríguez-López E,et al.Physiotherapy treatments in musculoskeletal pathologies associated with haemophilia[J].Hamostaseologie,2018,38(3):141-149.
[4]Mortazavi SMJ,Haghpanah B,Ebrahiminasab MM,et al.Simultaneous bilateral total knee arthroplasty in patients with haemophilia:a safe and cost-effective procedure?[J].Haemophilia,2016,22(2):303-307.
[5]Thès A,Molina V,Lambert T.Simultaneous bilateral total knee arthroplasty in severe hemophilia:A retrospective cost-effectiveness analysis[J].Orthop Traumatol Surg Res,2015,101(2):147-150.
[6]Arnold WD,Hilgartner MW.Hemophilic arthropathy.Current concepts of pathogenesis and management[J].J Bone Joint Surg(Am),1977,59(3):287-305.
[7]Chao Jiang,Yan Zhao,Bin Feng,et al.Simultaneous bilateral total knee arthroplasty in patients with end-stage hemophilic arthropathy:a mean follow-up of 6 years[J].Sci Rep,2018,8(1):1608.
[8]Suleiman LI,Edelstein AI,Thompson RM,et al.Perioperative Outcomes Following Unilateral Versus Bilateral Total Knee Arthroplasty[J].J Arthroplasty,2015,30(11):1927-1930.
[9]Borges JHDS,Júnior PL,Dias DM,et al.Cost and safety evaluation of simultaneous bilateral total knee arthroplasty versus unilateral knee[J].Rev Bras Ortop(Sao Paulo),2019,54(6):709-713.
[10]Rodriguez-Merchan EC.Simultaneous bilateral total knee arthroplasty in hemophilia:Is it recommended?[J].Expert Rev Hematol,2017,10(10):847-851.
[11]Thadi M,Mane PP,Sharma A.Challenges in successful management of haemophilic knee arthropathy:Our experience in a tertiary centre[J].J Orthop,2019,19(12):194-198.
[12]Mutsuzaki H,Watanabe A,Komatsuzaki T,et al.Investigation of perioperative safety and clinical results of one-stage bilateral total knee arthroplasty in selected low-risk patients[J].J Orthop Surg Res,2018,13(1):14.
[13]Fillingham YA,Ramkumar DB,Jevsevar DS,et al.The safety of tranexamic acid in total joint arthroplasty:a direct neta-analysis[J].J Arthroplasty,2018,33(10):3070-3082.
[14]Song SJ,Bae JK,Park CH,et al.Mid-term outcomes and complications of total knee arthroplasty in haemophilic arthropathy:a review of consecutive 131 knees between 2006 and 2015 in a single institute[J].Haemophilia,2018,24(2):299-306.
[15]Kim JL,Park JH,Han SB,et al.Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty:a meta-analysis[J].J Arthroplasty,2017,32(1):320-325.
[16]Rodríguez-Merchan EC.Total knee arthroplasty in hemophilic arthropathy[J].Am J Orthop(Belle Mead NJ),2015,44(12):E503-507.
[17]Moore MF,Tobase P,Allen DD.Meta-analysis:outcomes of total knee arthroplasty in the haemophilia population[J].Haemophilia,2016,22(4):e275-e285.
[18]Kapadia BH,Boylan MR,Elmallah RK,et al.Does hemophilia increase the risk of postoperative blood transfusion after lower extremity total joint arthroplasty?[J].J Arthroplasty,2016,31(7):1578-1582.
[19]Rodriguez-Merchan EC.Risks and patient outcomes of surgical intervention for hemophilic arthropathy[J].Expert Rev Hematol,2019,12(5):325-333.
[20]Anderson JA,Mason JA,Halliday B.Clinical outcomes and patient satisfaction following total hip and knee arthroplasty in patients with inherited bleeding disorders:a 20-year single-surgeon cohort[J].Haemophilia,2018,24(5):786-791.
[21]Silva MS,Rodrigues-Pinto R,Rodrigues C,et al.Long-term results of total knee arthroplasty in hemophilic arthropathy[J].J Orthop Surg(Hong Kong),2019,27(1):1-6.
[22]Ljung R,Auerswald G,Benson G,et al.Inhibitors in haemophilia A and B:Management of bleeds,inhibitor eradication,and strategies for difficult-to-treat patients[J].Eur J Haematol,2019,102(2):111-122.
[23]Tsay EL,Grace TR,VailT,et al.Bilateral simultaneous vs staged total knee arthroplasty:Minimal difference in perioperative risks[J].J Arthroplasty,2019,34(12):2944-2949.
[24]加亨,梁治权,方锐,等.双膝骨性关节炎患者未行二期膝关节置换的影响因素[J].中国组织工程究,2012,16(52):9707-9711.