| ObjectiveTo evaluate the clinical efficacy of total knee arthroplasty(TKA)for the treatment of hemophilia arthritis.MethodsFrom January 2010 to Jun 2016,28 hemophilic arthritis patients(34 knees)were treated with TKA,6 patients received bilateral TKA treatment,10 received TKA on the left side,and 12 received right TKA on the right side.All patients were male with the average age of 36.18 + 9.58 years old and average body weight of 66.00 + 8.27 kg.The levels of blood clotting factors ? and IX were monitored preoperatively and the routine processes of replacement therapy were applied for all patients.According to hemophilia type,there were 18 hemophilia A patients(23 knees)and 10 hemophilia B patients(11 knees).The average age of hemophilia A patients was 37.22± 10.07 years old and the average body weight was 67.33 ±7.40 kg.Routine process of freeze-dried human blood clotting factors ? replacement was performed to these hemophilia A patients.Among them,5 patients received bilateral TKA,7 received the left TKA,and 6 received the right TKA.The average age of hemophilia B patients was 34.30±8.81years old and average body weight was 63.60±9.58 kg.They received the routine process of human prothrombin complex concentrates replacement.Among these hemophilia B patients,1 were received bilateral TKA,3 patients received the left TKA and 6 received the right TKA.Before operation by the Hospital for Special Surgery(HSS)knee scoring system,Lysholm knee function score and Arnold-Hilgartne imaging classification to score of knee joint function and damage,postoperative follow-up of patients with knee joint pain,understand the function and imaging changes.And again using the scoring system for evaluation of clinical efficacy.ResultThe average follow-up time for all of the patients was 40.43 ±22.72 months,of which 8 patients were followed up for more than 5 years.In this study,One patient appearred right knee joint infection at 10 months after double TKA and second stage revision of the right knee joint was performed.Except this case,no femoral or tibia fractures,blood vessel or nerve injury occurred during this study.The average hospital stay of hemophilia A patients was 27.50 ± 9.87 days.The mean reduction of HGB after TKA operation was 42.44±22.07 g/L.It is worth mentioning that HSS and Lysholm scores both had statistically significant improvements(P<0.01),with the HSS preoperative value of 43.50± 10.80 to postoperative 85.72±6.24 and Lysholm preoperative score of 40.61 ±12.38 to 88.28±6.90 respectively.The mean hospital stay of hemophilia B patients were 18.60 ±9.88 days.After TKA surgery,their mean reduction of HGB was 43.10±28.45 g/L.Similar to hemophilia A patients,the improved scores of HSS and Lysholm for hemophilia B patients both had statistical significance(P<0.01),from preoperative 41.30±9.71 to postoperative 87.90±5.86 and 31.00 ±19.38 t0 88.40 ±7.17 respectively.The HSS score of all patients increased from 42.71 ± 10.30 to 86.50±6.09,and the Lysholm score imcreased from 37.18± 15.61 to 88.32±6.86.All the patients in the postoperative radiographic evaluation showed no periprosthetic osteolysis,translucent lines and prosthesis loosening.The satisfaction degree of all patients reached as high as 88.24%.ConclusionTKA is an effective treatment method for hemophilic arthritis to relieve the pain and further recover the function of the knee joint.Therefore,it achieves satisfying TKA early and midterm results for both hemophilia A and B patients. |
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