Curative Effect Of Comprehensive Surgical Treatment Of Hemophilia Advanced Knee Arthritis

Objective: To evaluate the clinical efficacy ofhuman coagulation factor VIII replacement therapy with tranexamic acid and "cocktail" therapy in total knee arthroplasty for advanced hemophilic knee arthritis.Methods: The clinical data of 18 patients with advanced hemophilic knee and 41 patients with knee osteoarthritisunder the treatment of total knee arthroplasty from June 2014 to October2017 were analyzed retrospectively.The advanced hemophilic knee patients were divided intogroup A with the treatment of human coagulation factor VIII replacement therapy combined with tranexamic acid and “cocktail”therapy.The knee osteoarthritis patients with the treatment of tranexamic acid and "cocktail" therapywere divided intogroup B,and without tranexamic acid and "cocktail" therapy were divided intogroup C.Record Analyze and compare the blood loss,related hematological parameters,VAS scores,and knee joint HSS scores of the three groups to evaluate the curative effect.Results:The data of 59 patients includedwere complete.Data analysis showed postoperative drainage flow(387.31±18.77ml)in group Awas much than group B(270.62±22.13ml),but lower than group C(424.70±23.62ml),the difference was statistically significant(P<0.05).There was no significant difference between the three groups in intraoperative blood loss and preoperative VAS scores(P>0.05),but the postoperativeVAS scores of the groups A,B,and C were 0.75±0.07,0.81±0.14,and 2.90±0.16,respectively.The postoperativeVAS scores of group A and B were significantly lower than group C(P<0.05).The preoperative HSS scores of groups A,B and C were 30.05±2.28,35.72±1.93,and34.29±0.89,the difference between groups was significant(P<0.05).The 3 months after postoperative HSS scores were 82.33±1.34,85.75±0.82,and 84.82±0.83,respectively.The 3months after postoperative HSS scores in group A were lower than group B and C,the difference between groups was significant(P<0.05).However,the HSS scores in groups A,B,and C were significantly higher than before the operation(P<0.05).One patient with knee osteoarthritisdeveloped Venous thrombosis,no complications such as pulmonary embolism?common peroneal nerve palsy?prosthetic joint infections?Periprosthetic fractures occurred.Conclusions: The treatment which undergoing total knee arthroplastywith coagulation factor VIIIreplacement therapy combined with TXA and "cocktail" therapy can reduce perioperative blood loss,postoperative pain,improve knee function and qualitylife of patients advanced knee arthritis.Tranexamic acid and "cocktail" therapy did not have adverse effects on patients after surgery.