Influencing factors of the outcome of Hemophiliac Patients after Knee replacement, with equal important psychological factors

Abstract

Abstract Objective To investigate the functional recovery of the knee joint post-total knee replacement in patients with hemophilic knee arthritis and to identify influencing factors on surgical outcomes. Methods We collected data on 87 hemophilia patients who underwent total knee replacement at our hospital from January 2010 to December 2020. Follow-up was conducted via telephone and in-person visits. Assessment of knee replacement efficacy employed the Hospital for Special Surgery (HSS) knee score, the American Knee Society's Clinical (KSC) and Functional (KSF) scores. Logistic regression analysis was utilized to examine potential predictors of postoperative outcomes, encompassing continuous variables such as age, range of motion (ROM), hematocrit (HCT), visual analog scale (VAS) for pain, body mass index (BMI), flexion contracture, and Hamilton Depression Scale (HAMD). Categorical variables included coagulation factor usage regularity, hemophilia typing, and severity grading. We classified patients into groups based on hemophilia type (Type A or B), severity (mild, moderate, or severe), and regularity of coagulation factor usage (regular or irregular) for analysis. Results Key factors impacting knee replacement outcomes in hemophiliac patients were ROM, flexion contracture, VAS, HAMD, coagulation factor usage regularity, and hemophilia severity. Univariate analysis revealed significant inter-group differences in hemophilia severity regarding KSC, HSS, and KSF scores (P < 0.05), as well as in coagulation factor usage regularity for KSF and HSS scores (P < 0.05). Significant differences were also noted in ROM, number of flexion contractures, VAS, and HAMD across KSC and KSF scores. Multivariate analysis indicated that hemophilia severity, ROM, and HAMD were significant predictors, with severity and HAMD negatively impacting, and ROM positively impacting postoperative outcomes. Conclusion For hemophiliac patients, ROM positively correlates with knee replacement success, while flexion contracture has a negative correlation. Higher HAMD scores, irregular coagulation factor usage, and greater hemophilia severity are associated with poorer knee function postoperatively. Clinical practice should emphasize regular coagulation factor usage and address the psychological well-being of patients with hemophilia to improve treatment outcomes.