Features of preoperative preparation in the treatment of the knee joint in patients with hemophilia

Abstract

Hemophilia is considered a hematological-orthopedic disease that develops as a result of damage to various anatomical structures of the musculoskeletal system, among which the synovial joints (so-called "target joints") dominate in almost all patients with hemophilia. The purpose of the study was to develop and implement a modern preoperative preparation algorithm for surgical treatment of knee joint pathology in patients with hemophilia. In order to carry out our research, we analyzed 61 cases of hemophilia that were under inpatient and outpatient treatment at the "Kyiv City Clinical Hospital No.9" in the period from 2008 to 2022. Open or arthroscopic knee synovectomy was performed in 22 (36.1%) examined patients of our study. Indications for synovectomy were the presence of hemarthrosis 4–5 times a year or more, presence of deformity and pain syndrome. Total knee arthroplasty was performed in 39 (63.9%) patients. The indication for this operation was the presence of deforming arthrosis of the knee joint with impaired walking and standing function.The expanded algorithm of preoperative preparation included additional instrumental methods of research and calculation of the deficiency of blood coagulation factors, which made it possible to prevent hemorrhagic complications in this category of patients. Operations on patients with hereditary coagulation disorders should be performed under the supervision of hematologists specializing in coagulation disorders and preferably working in specialized centers that have all the necessary resources for the proper diagnosis and treatment of hemophilia. In order to minimize the risks of hemorrhagic complications, we strongly recommend treating such patients with the participation of a multidisciplinary team of specialists, drawing up an individual therapy plan before the operation, and conducting the operation in centers specializing in the treatment of patients with hemophilia. Keywords: orthopedics, hematological and orthopedic diseases, preoperative preparation algorithms.