Clinical Outcome After Total Knee Arthroplasty In Hemophilic Arthropathy Patients With Stiff Knees

Objective: The purpose of the study was to parsing the clinical functional score,quality of life outcome after TKA performed in hemophilic arthropathy with stiff knees.Methods: Eleven patients(15 knees)undergoing TKA with stiff knees were retrospectively evaluated from March 2015 to December in our hospital,seven patients were hemophilia A,four patients were hemophilia B.The ROM of all the knees were less than 50°.According to different joint deformities,the patients were divided into straighten stiff(group A)and the flexion contracture(group B),group A contains 7 knees average age 30.3±8.7 years(range,24-45),group B contains 8 knees average age 37.5±10.13 years(range,24-49).According to the Hemophilic Expert Consensus recommendations,clotting factor ? and prothrombin complex concentrates were used for Hemophilia A and B separately.Clinical assessment included ROM,the Hospital for Special Surgery score(HSS)and complication.Functional evaluation and pain status were assessed using The WOMAC Index of Osteoarthritis and SF-36.Results: Mean follow-up of group A was 12.7±4.68 months(range,6–20),average follow-up of group B was 9.8±3.1 months(range,6-12),three of the patients performed bilateral TKA during one surgery,one patient did bilateral TKA with two surgeries in one year.Complications of joint dislocation,prosthetic loosening,periprosthetic fracture and prosthetic joint infections were not found.During the using of coagulation factor for continuous replacement therapy,none had a DVT or hemorrhage and clotting factor inhibitor was negative.In group A,ROM improved from 20.86° preoperatively to 90.29° postoperatively,HSS increased from 42.3 to 86.3 points,WOAMC increased from 45.7 to 86.7 points,PCS increased from 31.5 to 60.4 points,MCS increased from 38.3 to 51.9 points.In group B,ROM improved from 28.13° preoperatively to 81.52°postoperatively,HSS increased from 35 to 83.3 points,WOAMC increased from 49.9 to 84.6 points,PCS increased from 36.3 to 64.1 points,MCS increased from 40.9 to 57.7 points.All these differences between preoperative and postoperative were statistically significant(P<0.05),the differences between A and B were not significant(P>0.05).Conclusion: There were no differences on functional outcome between straighten stiff and flexion contracture hemophilic arthropathy,both of their knee function and the quality of life were improved significantly,obtained satisfactory functional outcomes.The patients with serve pain and seriously affecting the quality of life could choose TKA to improve function.Total knee arthroplasty is an effective procedure in treatment of HA,but the rate of revision surgery will gradually increase year by year,the long term follow-up is necessary.