Understanding the risks of total hip arthroplasty in patients with von Willebrand’s disease

Abstract

Purpose: Patients with von Willebrand’s disease (VWD) have either a qualitative or quantitative deficiency in a key clotting protein called von Willebrand’s factor. Type Ⅰ disease is the most common variant, but its clinical implications in total hip arthroplasty (THA) are unclear. Our purpose is to describe the perioperative impact of VWD in THA. Methods: We retrospectively reviewed a total of 17 primary THAs in 14 patients with type Ⅰ VWD performed between 2008 and 2019. Almost all cases (88%) received tranexamic acid, and most (59%) received DDAVP. All patients had a direct anterior approach (DAA) THA. Results: None of these cases required a blood transfusion. Mean estimated blood loss was 229 mL, and the mean hemoglobin dropped from 13.9 g/dL to 10.2 g/dL. There were no major bleeding complications. After a mean follow-up of 4 years, the mean hip disability and osteoarthritis outcome score, junior (HOOS, JR) was 79, and there were no reoperations or revisions for any cause. Conclusion: Patients with type Ⅰ VWD do not experience severe bleeding with routine chemoprophylaxis combined with DAA THA.