Analysis Of Related Factors Affecting The Curative Effect Of Total Knee Arthroplasty In Patients With Hemophilia A

Objective:Hemophiliac knee arthritis(HKA)is caused by repeated bleeding of knee joint in patients with hemophilia(PWH).End-stage patients often show swelling,pain,limited movement,joint instability,bone defect,knee joint function and quality of life decline.Total knee arthroplasty(TKA)has become an effective treatment for end-stage hemophiliac arthritis(EHA)patients on the basis of supplementation of coagulation factors.But the curative effect of hemophilia patients after total knee arthroplasty is not as good as that of non-hemophilia patients.It has higher complications and lower knee motion.This paper analyzed the cases of hemophilia patients in recent years,and carefully analyzed the factors affecting the curative effect of total knee arthroplasty in hemophilia patients,so as to avoid risks and improve the curative effect.Method:PWH who undergoing total knee arthroplasty in our hospital from January 2015 to January 2019 were collected for follow-up by telephone or by visiting the hospital.To evaluate the effect of total knee arthroplasty with the HSS score of the knee joint,and to analyze the factors influencing the HSS score of the knee joint after total knee arthroplasty.Preliminary factors included HSS score before knee surgery,ROM increase after knee surgery,preoperative flexion angle of knee joint,operation time,quadriceps femoris tendon reconstruction,and preoperative ROM of knee joint.Gradually incorporated into the correlation analysis,only the preoperative ROM and HSS scores of knee joint were correlated with the HSS scores of knee joint after arthroplasty.The factors affecting the preoperative ROM and HSS scores of knee joint were analyzed.Result : Pearson correlation analysis showed that the factors affecting the postoperative knee HSS score were knee preoperative HSS score(r=0.69,p<0.01),quadriceps formation(r=-0.63,p<0.01).Surgical time(r=0.52,p<0.05),postoperative knee flexion angle(r=0.70,p<0.01),preoperative knee ROM(r=0.79,p<0.01),knee ROM enhancement(r =0.79,p<0.01),postoperative knee ROM(r=0.49,p=0.54).The above factors were included in the stepwise regression analysis.The most importantfactor affecting the postoperative knee HSS score was preoperative knee joint.Activity degree(R=0.791,p<0.01).Conclusion:The ROM of knee joint and HSS score of knee joint before operation are significantly correlated with the curative effect after total knee arthroplasty in patients with hemophilia.We should try to improve the range of motion and function score of knee joint before operation in patients with hemophilia so as to obtain better curative effect after operation.