Total knee replacement in patients with hemophilia with severe axial deformation and combined instability

Abstract

We have analyzed results of treatment of 23 (30 knee joints) patients, including Hemophilia A – 22 cases (73.3 %) and Hemophilia B – 8 (26.7 %), with III–IV stages of hemophilic arthropathy, who were operated on for severe combined instability and various types of deformations: varus – 8, valgus – 11, recurvation – 2, “сompensated” valgus-varus – 3; totally 30 TKRs. In 7 patients (30.4 %) both knee joints were operated on. TKR of the right knee joint – 16 (53.3 %), left – 14 (46.7 %). With flexion contracture – 6 cases, mixed – 20, rigidity – 4. In 19 cases (63.3 %) deviation of the lower limb axis was >10°.We used: X-ray, topogram of lower extremities, CT.For coagulation status assessment we used: screening coagulation test, levels of scarce coagulation factors (FVIII, FIX), inhibitor of coagulation factor (FVIII, FIX) level.Function was evaluated before and at 1–9 years postoperatively using KSS, Oxford and VAS scales.Statistical analysis – STATISTICA 6.0, p < 0.05.An integrated approach to patients’ management by the use of preoperative planning, surgical techniques, selection of an endoprosthesis of the necessary design and a personalized program of hemostasiological support in the perioperative period that we developed allowed us to obtain excellent results in 1-year period after the operation according to the KSS rating scale in 26 (86.7 %) cases, good in 3 (10 %) cases, satisfactory – in 1 (3.3 %). On the Oxford scale, excellent results were obtained in 25 (83.3 %) cases, good in 4 (13.3 %) cases, satisfactory in 1 (3.3 %). 1–9 years after the operation, no statistically significant differences were obtained in the results with data of 1 year (p > 0.05).The developed tactics of hemostatic replacement therapy and laboratory control provided satisfactory hemostasis in the perioperative period.