Abstract
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Advanced hemophilic knee arthropathy is a frequent and devastating manifestation of severe hemophilia with significant implications for activities of daily living.
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Hemophilic arthropathy is caused by repeated bleeding, resulting in joint degeneration, pain, deformity and disability.
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In patients with hemophilia and advanced disease, total knee arthroplasty (TKA) has proven to be the most successful intervention, improves physical function and reduces knee pain.
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Hemophilic patients carry additional risks for complications and required specific pre/postoperative considerations. Expert treatment center should be used to improve patient outcome.
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Hemophilic patients present significant surgical challenges such as joint destruction, bone loss, severe ankylosis and oligoarticular involvement. The surgeon performing the arthroplasty must be experienced to manage such problems.
Introduction
Hemophilia is a hereditary X-linked recessive coagulopathy disorder resulting from blood clotting factor deficiency or dysfunction. There are two major types of hemophilia namely hemophilia A, deficiency of clotting factor VIII and hemophilia B, deficiency of clotting factor IX. These factors are involved in the intrinsic pathway of blood coagulation. The degree of severity is based on the plasma factor levels and can be classified into mild, moderate and severe, with either 5–40%, 1–5% or less than 1% of the normal factors level, respectively (1). The reported prevalence is 1/10 000, with hemophilia A being four times more frequent than hemophilia B (2). Since hemophilia is a X-linked disorder, it is predominantly seen in males. About 55% of the hemophilic population is mildly affected (2). Hemophilia is usually managed with lifelong factor replacement therapy that helps in reducing bleeding complication rates and prolonging life expectancy.
Hemophilic arthropathy
There is a great variety of clinical manifestations of hemophilia but one of the most frequent is spontaneous intra-articular bleeding. It accounts for more than 90% of serious bleeding in patients with severe hemophilia (3). Hemarthrosis mainly affects the ankle, elbow and knee (4). Hemophilic arthropathy (HA) is a blood-induced joint damage caused by repetitive intra-articular bleeding in the joint which leads to the deposition of hemosiderin in the synovial tissues inducing hypertrophy, neovascularization and fibrosis of the latter. The synovial inflammation and associated inflammatory reaction are responsible for cartilage damage and early joint degeneration (5). Hemarthrosis may occur as frequently as 20–30 times per year in severe cases (6), and it usually starts at a young age, leading to the advanced arthropathies seen in young adults (7). This can lead to significant joint pain and deformity, resulting in major limitations and poor quality of life (8) (Fig. 1). In severely affected knees, stiffness and flexion contracture are frequently found. In addition, important angular deformities (varus or valgus), external rotation of the tibia and leg length discrepancy can be observed (9, 10) (Fig. 2). Early (age 1–2) prophylactic recombinant factor administration can prevent or slow the progression of joint damage (1, 11).
Treatment options
HA is commonly seen in the knee joint secondary to repetitive hemarthrosis. In the early stage, knee arthropathy is treated with conservative management including physiotherapy and pain medications. However, as the degenerative changes progress, pain and disability increases and conservative management stops being effective (12). Depending on the severity of the disease, different elective procedures may be indicated such as arthroscopic or open synovectomy, arthrodesis and/or arthroplasty (13). A quick overview of these procedures is provided in this article.
Synovectomy
Patients with HA have an inflamed, hypertrophic and hyper-vascularized synovium which leads to intra-articular bleeding and pain. Therefore, the objective behind performing a synovectomy is to remove the inflamed and hypertrophic synovial tissue, consequently reducing bleeds and pain. This can be achieved either by surgery, chemical intra-articular injection of a fibrosing substance (such as rifampicin or oxytetracycline) or radioactive injection of radiopharmaceutical, beta-emitting radionuclide (14, 15, 16).
Surgical synovectomy is indicated in patients with subacute or chronic synovitis with moderate radiological score and no response to medical treatment for more than 6 months. Surgical synovectomy can be performed either open or arthroscopic. Open surgical synovectomy is mainly carried out using dual incision: anteromedial and posterolateral (17). It is effective in reducing the number of bleeding episodes by more than 80% (16, 17). However, postoperative loss of motion is an undesired consequence of this operation (16, 18), moreover it does not stop the progression of end-stage knee arthritis. Thus, it is not commonly recommended or performed.
On the other hand, arthroscopic synovectomy is a less invasive technique that is performed using the standard arthroscopic knee portals, allowing for faster recovery, shorter hospital stay and improved postoperative range of motion (ROM) (16). It also reduces the bleeding episodes and good outcomes have been reported (18, 19). Dunn et al. reported median reduction in bleeding episodes of 84% (20). Interestingly, according to Journeycake et al., arthroscopic synovectomy should be considered early in young patients with hemophilia (PWH), as they could show more favorable outcomes (76% improvement in joint function) compared to older patients (19). In addition, it has been suggested that physiotherapy is a key element for the success of this procedure (16). Overall, arthroscopic synovectomy can delay but not stop the progression of end-stage arthritis and can be an interesting surgical option in young patients with chronic synovitis.
Knee arthrodesis
Arthrodesis is a procedure with good results in monoarticular disease. However, hemophilia may affect multiple joints, thus using this therapeutical solution on several affected joints might create complex biomechanical problems and disabilities in the daily activities. Moreover, with the current advancement in knee arthroplasty, knee arthrodesis is rarely recommended.
Total knee arthroplasty
Total knee arthroplasty (TKA) is considered the gold standard treatment for patients with end-stage HA. TKA has been shown to significantly improve knee function, reduce pain and provide high patient satisfaction rates (Fig. 3) (21). However PWH differ from patients with primary knee osteoarthritis (OA) as they carry additional risk for complications and therefore special attention and considerations is required in the preoperative, intraoperative and postoperative care. The rest of this article will focus on these special considerations and the outcome of TKA in HA patients.
Preoperative preparation and tips and tricks for TKA in HA knees
All elective surgical procedures in PWH should be managed in expert treatment centers (22). A multidisciplinary approach with effective communication and coordination between the orthopedic surgeon, hematologist, pharmacist, anesthetist and physiotherapist is essential to ensure the success of the surgical procedure.
Coagulation factor substitution therapy
Optimizing coagulation factor levels for patients undergoing surgery is a key element in the therapeutic management of PWH. Different protocols and suggestions have been published in the literature. The world Federation of Hemophilia recommends a desired preoperative factor level of 80–100% for major surgeries such as TKA in hemophilia A and 60–80% for hemophilia B, with postoperative levels gradually tapering to approximately 50% until the wound is healed (23). Others recommend a level of 120% (corresponding to 60 UI/kg and 120–140 UI/kg, respectively, for factor VIII and IX deficiency) during induction of anesthesia and 60–80% for 72 h post-surgery (achieved by either continuous infusion or bolus) (24). Factor levels should be progressively tapered over the next 3–4 weeks postoperative (typically 50% for 2 weeks followed by 20–40% for two more weeks), while keeping the factors at 40% before each physical therapy session up to 6 weeks (24). Keeping an appropriate coagulation factors level is essential to decrease complication rates and ensure good outcomes. Figgie et al. showed a significant decreased in infection and failure rates following TKA in PWH with postoperative clotting factor levels of 100% (25).
Currently, there is no well-established clotting factor substitution protocol for PWH undergoing TKA.
Preadaptation
Conversely to the primary OA cases, preoperative physiotherapy does not improve the outcome in PWH (26, 27, 28).
Perioperative challenges in primary TKA in patients with HA
TKA in HA knees is very challenging and demands advanced expertise in knee arthroplasty and revision knee arthroplasty to be able to deal with altered anatomy, bony defects and other technical challenges that may be encountered during the surgery.
Although, it is generally recommended to perform TKA under spinal anesthesia in the non-hemophilia patients as it is associated with lower postoperative complications compared to general anesthesia (29), general anesthesia is still recommended by some for PWH (30, 31). This is due to the fact that PWH carry a higher risk of local hemorrhages and related permanent neurological damages with spinal anesthesia (30, 31). However, Moharrami et al. recently reported no difference in terms of complications between general and spinal anesthesia in PWH (32). Nevertheless, they still recommend general anesthesia for bilateral and long cases (32).
For PWH, prophylactic antibiotics with cefazolin 2 g preoperative then 1 g/8 h for 24–48 h or vancomycin for allergy cases is recommended (33).
Tourniquet use is still widespread for TKA in the hemophilic population. The tourniquet can be either inflated during the entire procedure, only during component cementing or until beginning of wound closure (34, 35, 36, 37).
To perform meticulous hemostasis, the authors prefer avoiding tourniquet. Moreover, tourniquet use may cause thigh bleeding secondary to microvascular damages (38).
As in the non-hemophilic population, skin incision depends on whether the patient had previous surgery or not. In case of previous scars, the most lateral incision is used to protect the blood supply to the skin and transverse scars should be crossed perpendicular to the scar. Large skin flaps may carry a risk of superficial hematoma and skin necrosis, dissection should be limited to prevent those. Otherwise, a standard midline incision is used followed by medial parapatellar approach (39).
HA knees are characterized by the presence of arthrofibrosis and limited ROM, which makes surgical exposure more difficult. Medial and lateral gutters are often scar down leading to decreased patello-femoral mobility (40). Thick fibrous tissues may also breach across the cartilage area, preventing motion. Extensive synovectomy is recommended to help with exposure and decrease the risk of future bleeding. Tissues crossing the femoro-tibial joint or patella-femoral joint should be excised. Extensile approaches including quadriceps snip, V-Y quadricepsplasty and tibial tubercle osteotomy might be required to allow adequate exposure of the knee joint in severe cases of arthrofibrosis in HA knees. Although in the authors’ experience it is usually not necessary, quadriceps snip and V-Y quadricepsplasty, are performed in 10% and 39% of cases respectively, by some to achieve better exposure when necessary (34, 36, 37). Regarding tibial tubercule osteotomy, the authors attempt to avoid it, sharing Strauss et al. concerns on bad bone quality and soft tissue coverage linked to muscle atrophy (34).
Once sufficient exposure has been obtained, bone cuts should be performed according to the surgeon’s preferred alignment philosophy and surgical workflow. The authors prefer using restricted kinematic alignment (rKA) principles since it decreases the need for soft tissues release and further bleeding (41, 42). Although the efficiency of navigation to decrease blood loss has not been proven in the general population, the authors consider that HA is a good indication for its use. Not opening the femoral canal seem advantageous in this subset of the patient.
Because of the abnormal shape of the distal femur (wide medial-lateral diameter, relatively narrow antero-posterior, wide femoral notch and large defects and osteophytes) and the frequent preoperative fixed flexion contracture, obtaining full extension is often difficult. As in the general population, increased distal resection and soft tissue release of the posterior capsule are both options to correct fixed flexion contracture. However, in PWH, posterior release needs to be done with extreme caution as any bleeding in this area would be very difficult to control.
In the authors’ opinion, when the patella is subluxed (thus the extensor mechanism at a side), good flexion is usually obtained, and the knee can be balanced. However, once the patella is reduced (and thus the extensor mechanism), there is often a significant decrease in the ROM due to quadriceps fibrosis following multiple intramuscular bleeding. However, it is still not advised to release the quadriceps muscle because it increases the risk of bleeding without bringing any benefit. Since muscle fibrosis is in cause, some postoperative improvement is possible and has been noted with physiotherapy.
Different authors have reported on using different types of bearings with good outcomes including cruciate retaining (CR) prosthesis and posterior stabilizing (PS) prosthesis (25, 43).
As with the general population, the aim is to obtain a balanced TKA with the least constraint (44). Increasing the constraint level leads to greater contact stresses on the implant interface (45), potentially resulting in premature implant loosening (46).
However, due to muscular atrophy and knee angular deformities (varus or valgus) found in PWH, achieving prosthetic stability with standard TKA implants can be challenging.
For these reasons a semi-constraint implant and rotating-hinge implant should be available as a backup when severe preoperative deformities are present and in case of collateral ligament insufficiency (31, 44).
In our center, when possible, the authors use a standard cemented primary TKA, with a medial congruent polyethylene, following rKa principles. However, in many cases, severe ankylosis, soft tissue contractures and bone loss are present. Such anatomy modifications do not always allow to follow rKA principles, and increased bone resection and/or soft tissue releases are required (45, 46). Such cases can often be anticipated based on preoperative imaging, and mechanical alignment philosophy is applied. When more constraint is needed, the authors tend to use short cemented stems. In our experience, with rKA, those stems are not impinging within a defined range of varus/valgus 5°. If longer stems are needed or if bone anatomy is too altered, we follow a pure mechanical alignment philosophy.
Performing patella resurfacing remains controversial (47). Whether or not the patient has hemophilia, the authors perform selective patella resurfacing depending on the status of the patella cartilage surface. Because of the erosive nature of HA, it is often necessary (Fig. 4). Care must be taken to preserve sufficient bone thickness to avoid the risk of fracture.
Most authors agree that the use of cement is recommended in the hemophilia population (31, 37, 48). PWH are prone to high risk and prevalence of periprosthetic joint infection (PJI). Therefore, the authors recommend the use of antibiotic-loaded cement in PWH for precautionary reasons (31), the risk-balance benefit being clearly in favor, as for its use in TKA for primary OA, in many European countries. As an added benefit, cementing has been shown to decrease blood loss compared to uncemented TKA (49).
Furthermore, the authors place a Collatamp G (Schering-Plough, Stockholm, Sweden) with vancomycin powder to help with hemostasis, keep the gutter open, prevent exercise fibrosis and elude antibiotic over a few days. The literature is divisive on the potential benefits of vancomycin powder in non-hemophilic patients, and there is no recommendation for PWH undergoing TKA (50, 51).
Postoperative bleeding is a common complication of TKA in the hemophilic population. Administration of clotting factors and tranexamic acid (TXA) is proven to be effective to decrease blood loss and should therefore be administrated (24, 52, 53, 54). In addition, the authors recommend the use of topical TXA. Intraoperative bleeding is generally not very different than in the normal population since patients have normal levels of factors during the surgery. However, postoperative bleedings are usually increased. Careful hemostasis should be verified at the end of the procedure and additional adjunct to hemostasis can be used if needed.
Suction drains should be avoided, as Mortazavi et al.’s prospective randomized study demonstrated that the suction drain group had a statistically significant higher hemoglobin drop on day one compared to the no-drain group (55). Moreover, there was no difference regarding the functional outcomes between the two groups, which led them to conclude that the use of suction drain is of no benefit. To further diminish the bleeding, the use of extramedullary guides is recommended (56). The latter can be achieved using navigation-assisted TKA, robot-assisted TKA technology and patient-specific instrumentation (PSI) (57, 58). However, because of the limited perioperative adjustability of PSI, the authors don’t recommend its use.
Closure should be done in a watertight fashion, and advanced dressing should be used in this high-risk population. The authors prefer using closed incisional negative pressure wound therapy to decrease subcutaneous hematoma and seroma and improve subcutaneous tissue perfusion.
Physiotherapy
Postoperative physiotherapy is essential in PWH as it focuses on regaining ROM, strengthening and helping the patient retrieve adequate gait. The authors recommend unrestricted mobilization of the knee with the help of a physiotherapist for 7 days, as long as coagulation factors level is around 100%. Because of the increased risk of bleeding when coagulation factor administration is reduced, mobilization is also temporarily reduced. In the first six postoperative weeks, it is recommended that patients receive a minimum of 40% factor correction before every physiotherapy session to minimize the risk of bleeding due to knee movement (24). Different postoperative rehabilitation regimes have been reported including starting physiotherapy on the same day of surgery (36), while others suggested to start on the third postoperative day and continue twice a day duration of the hospital stay (24). A specialized physiotherapist in an expert treatment center will adjust manual therapy according to signs of bleeding and will collaborate with a hematologist to fine-tune factor replacement therapy if needed. Evidence for continuous passive motion machines is unclear. Although infrequently associated with complications, some authors advised for its positive effects on soft-tissue healing, swelling, joint function and hemarthrosis (28, 59). Even though, it does not enhance ROM at 1 and 2 years postoperatively, it is still recommended by some (28, 60).
Outcomes
Range of motion
HA is often associated with severe restricted preoperative ROM. Unlike non-hemophilic population where ROM of 0–120° is usually achieved after TKA (61), the increase of ROM in PWH is more modest (21). Goddard et al. reported the range of flexion and flexion contracture improved from 68° to 79° and 9.6° to 4.7°, respectively (62). Similar results were published by Kubes et al. and Silva et al. where TKA surgery decreased the average flexion contracture from 17° to 7° and 18° to 8° and improved the average preoperative flexion range from 73° to 80° and 59° to 75°, respectively (35, 63). Finally, a meta-analysis by Moore et al. showed an average decrease of 9.7° in flexion contracture and an increase 15° in flexion after TKA surgery (53).
Patient satisfaction
TKA in PWH has been associated with a high satisfaction rate. Silva et al. observed that 97% of the patients reported excellent or good function (63). Major improvement in postoperative pain explained the increased quality of life and high patient satisfaction. In Carulli et al.’s retrospective study, all 18 patients reported a high satisfaction rate, pain reduction and improved functional ability after TKA surgery with a mean follow-up of 12.2 years (64). Wang et al. found similar results with reported satisfaction rates of 100% (65). Zingg et al. demonstrated that patient’s satisfaction and the knee society functional score were very high after TKA in PWH (21).
Implant survival rate
Westberg et al. (66) observed a 5- and 10-year implant survival rate of 92% and 88%, respectively, in PWH. This is similar to other published results in which 5- and 10-year implant survivorship are 90–98% and 83–89%, respectively (62, 63, 67). These results are less favorable than non-hemophilic patients where 10-year implant survival rates oscillates between 92% and 95.5% (68, 69). However, Duffy et al. observed lower 10- and 15-year implant survival rate of 96% and 85%, respectively, in non-hemophilic patients younger than 55 years (mean age of 53 years) (70). The difference in implant survivorship between TKA in OA patients (usually older than 55 years) and PWH may be explained by the fact that the latter have different characteristics than the general population; usually younger males, often in their third or fourth decade, with higher activity level (63, 71). However, the higher implant survival rate reported in OA patients younger than 55 years when compared to PWH (usually younger than 55) could be explained by genetics, stiffness, poor bone quality and the complexity of the disease.
In terms of revision rate, Ernstbrunner et al. (72) reported 30% (18% for aseptic loosening and 12% for infection) at 18-year follow-up. They concluded that, with revision as an endpoint, the implant survival rate at 20 years was 59% (72). The high rate of aseptic loosening could be explained by micro-hemorrhages and reactive destructive reactions that first occur at the bone–cement interface, poor bone quality and younger age of the patients (72). The above-described low survival rate is in contradiction with Song et al.’s retrospective study on 131 TKA in a hemophilic population that reported 5- and 10- year implant survival rate to be 98.5% and 97.5%, respectively (43). Their explanation for the high discrepancy between those studies is the type of implant used (43).
Complications
The overall complication rate after TKA in PWH is 13–31.5% (43, 53, 65, 73), which is significantly higher than the rate after TKA in non-hemophilic patients, 7.1–8.7% (73). Some of these complications include infection, periprosthetic fracture, bleeding, neurovascular injury, loosening, patella complications and wound dehiscence. Aseptic loosening and infection are the most significant ones.
Postoperative intra-articular bleeding has been shown to be one of the most common complications following TKA in PWH. Song et al. showed a prevalence of 5.3–8.9% as well as Moore et al. in their meta-analysis (43, 53). Postoperative bleeding has been associated with increased blood transfusion, longer hospital stays, higher infection rate and worse clinical outcomes including stiffness (74, 75, 76). This led multiple authors to recommend keeping the factor levels at 100% postoperatively for up to 3 weeks following TKA (77, 78).
Blood loss is another common complication in PWH undergoing TKA. Recent studies have shown that the use of TXA can significantly reduce blood loss and therefore reduce the associated complications. Huang et al. reported on 34 PWH undergoing TKA. They showed that a combination of intravenous and intra-articular TXA significantly reduces perioperative blood loss, transfusion rates and postoperative knee swelling. Moreover, it improved joint pain and function postoperatively (79). Also, Rodriguez-Merchan et al. showed that PWH who did not receive TXA had a transfusion rate of 46.6% vs 0% in PWH who had TXA (80).
Wound dehiscence is another common complication. The latter is explained by edge bleeding, poor soft tissue quality and higher wound tension (73). In Li et al.’s retrospective study on 78 PWH, wound dehiscence was the second most frequent complication with a prevalence of 16.7% (73). Therefore, careful hemostasis and sufficient factor substitution after surgery is essential to prevent such complication.
Deep vein thrombosis (DVT) is another important complication that is usually easily prevented using chemical thromboprophylaxis after TKA in the general population. However, in PWH this practice is controversial, and the best treatment is still to be determined. Some authors including Cancienne et al. showed a high rate of DVT in PWH post-TKA with 3.2% compared to 1.4% in the general population (76). However, in contrast Botero et al. showed a 0.9% rate of DVT in the hemophilic population (81). Moreover, Peng et al. showed that the rate of bleeding in patients receiving low-weight molecular heparin post-TKA is estimated to be 50%, while the estimated overall incidence of major bleeding regardless of prophylaxis type is 39.1% (82). On the other hand, a retrospective single-center study by Holderness et al. found no increase in bleeding with enoxaparin in PWH undergoing hip and knee replacement (83). As the literature is contradictory, different authors have recommended different options. Goker et al. recommended the use of DVT chemoprophylaxis as they believe that since the patients are getting factor replacement then they should possess similar hemostasis characteristics as the general population (76). In contrast, Mortazavi et al. recommended to follow the AAOS and ACCP guidelines for patients with bleeding diathesis that recommends against the use of DVT chemoprophylaxis (37, 84). However, they recommend early ambulation and mechanical prophylaxis (37).
PJI is another major complication following TKA in PWH.The prevalence of PJI in the non-hemophilic population is around 1% (85, 86). However, most studies have shown significantly higher rates of PJI in PWH with prevalence ranging from 5% to 17% (21, 35, 66, 67). The reason behind the increased infection rate in the hemophilic population is still unknown (72); nevertheless, there are several explanations that have been proposed including poor skin condition caused by coagulation factor administration, immunosuppression, bacteremia from contamination during repeated intravenous self-administration of coagulation factor concentrate, increased incidence of postoperative hematoma or concomitant HIV or HCV infection (53, 87). Forty percent of PWH were found to have HIV (63). Literature is still contradictory on whether HIV increases the rate of postoperative infection in PWH. Some authors report similar infection rates in HIV-positive and HIV-negative patients (62, 67), while others found higher rates of infection in HIV-positive patients (62, 88, 89).
Simultaneous bilateral TKA
Simultaneous bilateral TKA (SBTKA) is a very interesting option for PWH as they often present with symptomatic bilateral knee HA (90, 91). SBTKA has multiple potential advantages including one admission, one operation, shorter overall hospital stay, one coagulation factor administration and cost-saving surgery compared to stage bilateral knee arthroplasty (92). Cost-effectiveness has been linked to the decreased consumption of the costly coagulation factors replacement therapy needed for surgery (91).
Mortazavi et al. reported a cost reduction of 45% in SBTKA when compared to staged bilateral TKA (90). Moreover, he showed that there was no statistically significant difference in knee society score, WOMAC score, short-form 36 score, complication rate, mean ROM and flexion contracture between the two groups (90). Their study concluded that SBTKA was safe and cost-effective for PWH with bilateral knee HA. Similar results have been published showing a decreased cost, ranging from 36% to 47% with SBTKA (91, 93, 94). In addition, Jiang et al. reported on 36 PWH with a mean follow-up of 6 years who underwent SBTKA. They found that SBTKA patients did not require increased coagulation factors replacement. Moreover, there were no significant differences in HSS score, ROM or implant survival rates when compared to unilateral TKA, which led them to conclude that SBTKA in PWH is a safe and cost-effective treatment with good mid-term outcomes (92).
Longer LOS, more difficult physiotherapy, increased transfusion rates and pain are commonly perceived drawbacks of SBTKA when compared to unilateral TKA. However, studies show no statistically significant difference in terms of LOS and transfusion rate (90, 92).
There is no literature to our knowledge, specifically focusing on physiotherapy and pain. However, in the general population, no difference between the two groups has been reported (95, 96).
Conclusion
TKA in PWH has been shown to significantly improve knee function and reduce pain, providing high patient satisfaction rates and good outcomes. However, PWH differ from patients with primary knee OA. ROM cannot always be fully restored and PWH carry additional risk for complications. To minimize complications and increase the success rate, special attention and consideration are required. It is essential that PWH are managed in expert treatment centers with a multidisciplinary approach.
ICMJE Conflict of Interest Statement
The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding Statement
This research was funded by the Maisonneuve-Rosemont Foundation.
References
- 1.↑
Peyvan di F, Garagiola I, & Young G. The past and future of haemophilia: diagnosis, treatments, and its complications. Lancet 2016 388 187–197. (https://doi.org/10.1016/S0140-6736(1501123-X)
- 2.↑
Berntorp E, & Shapiro AD. Modern haemophilia care. Lancet 2012 379 1447–1456. (https://doi.org/10.1016/S0140-6736(1161139-2)
- 3.↑
Pergantou H, Matsinos G, Papadopoulos A, Platokouki H, & Aronis S. Comparative study of validity of clinical, X-ray and magnetic resonance imaging scores in evaluation and management of haemophilic arthropathy in children. Haemophilia 2006 12 241–247. (https://doi.org/10.1111/j.1365-2516.2006.01208.x)
- 4.↑
Stephensen D, Tait RC, Brodie N, Collins P, Cheal R, Keeling D, Melton K, Dolan G, Haye H, Hayman E, et al.Changing patterns of bleeding in patients with severe haemophilia A. Haemophilia 2009 15 1210–1214. (https://doi.org/10.1111/j.1365-2516.2008.01876.x)
- 5.↑
Llinás A. Haemophilic arthropathy. Haemophilia 2010 16(Supplement 5) 121–121. (https://doi.org/10.1111/j.1365-2516.2010.02309_1.x)
- 6.↑
Ramgren O. Haemophilia in Sweden. III. Symptomatology, with special reference to differences between haemophilia A and B. Acta Medica Scandinavica 1962 171 237–242.
- 7.↑
Luck v. JV, Silva M, Rodriguez-Merchan EC, Ghalambor N, Zahiri CA, & Finn RS. Hemophilic arthropathy. Journal of the American Academy of Orthopaedic Surgeons 2004 12 234–245. (https://doi.org/10.5435/00124635-200407000-00004)
- 8.↑
Valentino LA. Blood-induced joint disease: the pathophysiology of hemophilic arthropathy. Journal of Thrombosis and Haemostasis 2010 8 1895–1902. (https://doi.org/10.1111/j.1538-7836.2010.03962.x)
- 9.↑
Rodriguez-Merchan EC. Musculoskeletal complications of hemophilia. HSS Journal 2010 6 37–42. (https://doi.org/10.1007/s11420-009-9140-9)
- 10.↑
Rodríguez-Merchán EC. Effects of hemophilia on articulations of children and adults. Clinical Orthopaedics and Related Research 1996 328 7–13. (https://doi.org/10.1097/00003086-199607000-00003)
- 11.↑
Manco-Johnson MJ, Abshire TC, Shapiro AD, Riske B, Hacker MR, Kilcoyne R, Ingram JD, Manco-Johnson ML, Funk S, Jacobson L, et al.Prophylaxis versus Episodic Treatment to Prevent Joint Disease in Boys with Severe Hemophilia. New England Journal of Medicine 2007 357 535–544. (https://doi.org/10.1056/NEJMoa067659)
- 12.↑
de la Corte-Rodriguez H, & Rodriguez-Merchan EC. The role of physical medicine and rehabilitation in haemophiliac patients. Blood Coagulation and Fibrinolysis 2013 24 1–9. (https://doi.org/10.1097/MBC.0b013e32835a72f3)
- 13.↑
Chin B, Wee I, Syn NL, O’Neill GK, Yap ES, & Koh PL. Surgery for chronic arthropathy in people with haemophilia. Cochrane Database of Systematic Reviews 2022 11 CD013634. (https://doi.org/10.1002/14651858.CD013634.pub2)
- 14.↑
Rodriguez-Merchan EC. Musculo-skeletal manifestations of haemophilia. Blood Reviews 2016 30 401–409. (https://doi.org/10.1016/j.blre.2016.04.008)
- 15.↑
Rodriguez-Merchan EC. Surgical approaches to hemophilic arthropathy. Blood Coagulation and Fibrinolysis 2019 30 S11–S13. (https://doi.org/10.1097/MBC.0000000000000824)
- 16.↑
Vulpen LFD, Thomas S, Keny SA, & Mohanty SS. Synovitis and synovectomy in haemophilia. Haemophilia 2021 27(Supplement 3) 96–102. (https://doi.org/10.1111/hae.14025)
- 17.↑
Mingo-Robinet J, Odent T, Elie C, Torchet MF, Glorion C, Padovani JP, & Rothschild C. Open synovectomy of the ankle joint in young haemophiliacs: mid-term to long- term results of a single-centre series of 32 procedures. Haemophilia 2015 21 e306–e311. (https://doi.org/10.1111/hae.12704)
- 18.↑
Wiedel JD. Arthroscopic synovectomy: state of the art. Haemophilia 2002 8 372–374. (https://doi.org/10.1046/j.1365-2516.2002.00606.x)
- 19.↑
Journeycake JM, Miller KL, Anderson AM, Buchanan GR, & Finnegan M. Arthroscopic synovectomy in children and adolescents with hemophilia. Journal of Pediatric Hematology/Oncology 2003 25 726–731. (https://doi.org/10.1097/00043426-200309000-00010)
- 20.↑
Dunn AL, Busch MT, Wyly JB, Sullivan KM, & Abshire TC. Arthroscopic synovectomy for hemophilic joint disease in a pediatric population. Journal of Pediatric Orthopedics 2004 24 414–426. (https://doi.org/10.1097/00004694-200407000-00013)
- 21.↑
Zingg PO, Fucentese SF, Lutz W, Brand B, Mamisch N, & Koch PP. Haemophilic knee arthropathy: long-term outcome after total knee replacement. Knee Surgery, Sports Traumatology, Arthroscopy 2012 20 2465–2470. (https://doi.org/10.1007/s00167-012-1896-7)
- 22.↑
Atilla B, & Güney-Deniz H. Musculoskeletal treatment in haemophilia. EFORT Open Reviews 2019 4 230–239. (https://doi.org/10.1302/2058-5241.4.180068)
- 23.↑
Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, et al.Guidelines for the management of hemophilia. Haemophilia 2013 19 e1–e47. (https://doi.org/10.1111/j.1365-2516.2012.02909.x)
- 24.↑
Wiedel J, Stabler S, Geraghty S, & Funk S. Joint Replacement Surgery in Hemophilia. World Federation of Hemophilia [Internet], pp. 1–10 2010. Available at: https://www.wfh.org
- 25.↑
Figgie MP, Goldberg VM, Figgie HE, Heiple KG, & Sobel M. Total knee arthroplasty for the treatment of chronic hemophilic arthropathy. Clinical Orthopaedics and Related Research 1989 248 98–107.
- 26.↑
Ackerman IN, & Bennell KL. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review. Australian Journal of Physiotherapy 2004 50 25–30. (https://doi.org/10.1016/s0004-9514(1460245-2)
- 27.↑
Beaupre LA, Lier D, Davies DM, & Johnston DBC. The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. Journal of Rheumatology 2004 31 1166–1173.
- 28.↑
Lobet S, Pendeville E, Dalzell R, Defalque A, Lambert C, Pothen D, & Hermans C. The role of physiotherapy after total knee arthroplasty in patients with haemophilia. Haemophilia 2008 14 989–998. (https://doi.org/10.1111/j.1365-2516.2008.01748.x)
- 29.↑
Paziuk TM, Luzzi AJ, Fleischman AN, Goswami K, Schwenk ES, Levicoff EA, & Parvizi J. General vs spinal anesthesia for total joint arthroplasty: a single-institution observational review. Journal of Arthroplasty 2020 35 955–959. (https://doi.org/10.1016/j.arth.2019.11.019)
- 30.↑
Van Veen JJ, Nokes TJ, & Makris M. The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. British Journal of Haematology 2010 148 15–25. (https://doi.org/10.1111/j.1365-2141.2009.07899.x)
- 31.↑
Rodriguez-Merchan EC. Special features of total knee replacement in hemophilia. Expert Review of Hematology 2013 6 637–642. (https://doi.org/10.1586/17474086.2013.856261)
- 32.↑
Moharrami A, Mafi AH, Fallah E, Salehi M, & Mortazavi SMJ. Total joint arthroplasty in the patients with haemophilia: general or neuraxial anaesthesia? Haemophilia 2022 28 e95–e97. (https://doi.org/10.1111/hae.14509)
- 33.↑
Rodriguez-Merchan EC. Preventing surgical site infection in haemophilia patients undergoing total knee arthroplasty. Blood Coagulation and Fibrinolysis 2012 23 477–481. (https://doi.org/10.1097/MBC.0b013e32835553dd)
- 34.↑
Strauss AC, Schmolders J, Friedrich MJ, Pflugmacher R, Müller MC, Goldmann G, Oldenburg J, & Pennekamp PH. Outcome after total knee arthroplasty in haemophilic patients with stiff knees. Haemophilia 2015 21 e300–e305. (https://doi.org/10.1111/hae.12698)
- 35.↑
Kubeš R, Salaj P, Hromádka R, Včelák J, Kuběna AA, Frydrychová M, Magerský Š, Burian M, Ošťádal M, & Vaculik J. Range of motion after total knee arthroplasty in hemophilic arthropathy. BMC Musculoskeletal Disorders 2018 19 162. (https://doi.org/10.1186/s12891-018-2080-0)
- 36.↑
Mortazavi SMJ, Haghpanah B, Ebrahiminasab MM, Baghdadi T, & Toogeh G. Functional outcome of total knee arthroplasty in patients with haemophilia. Haemophilia 2016 22 919–924. (https://doi.org/10.1111/hae.12999)
- 37.↑
Mortazavi SJ, Bagheri N, Farhoud A, Hadi Kalantar S, & Ghadimi E. Total knee arthroplasty in patients with hemophilia: what do we know? Archives of Bone and Joint Surgery 2020 8 470–478. (https://doi.org/10.22038/abjs.2019.42247.2149)
- 38.↑
Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, & Yang CY. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2011 19 1121–1130. (https://doi.org/10.1007/s00167-010-1342-7)
- 39.↑
Stern SH, & Insall JN. Posterior stabilized prosthesis. Results after follow-up of nine to twelve years. Journal of Bone and Joint Surgery. American Volume 1992 74 980–986. (https://doi.org/10.2106/00004623-199274070-00004)
- 40.↑
Maloney WJ. The stiff total knee arthroplasty: evaluation and management. Journal of Arthroplasty 2002 17(4) 71–73. (https://doi.org/10.1054/arth.2002.32450)
- 41.↑
Massé V, Cholewa J, & Shahin M. Personalized alignmentTM for total knee arthroplasty using the Rosa® Knee and Persona® knee systems: surgical technique. Frontiers in Surgery 2022 9 1098504. (https://doi.org/10.3389/fsurg.2022.1098504)
- 42.↑
Vendittoli PA, Martinov S, & Blakeney WG. Restricted kinematic alignment, the fundamentals, and clinical applications. Frontiers in Surgery 2021 8 697020. (https://doi.org/10.3389/fsurg.2021.697020)
- 43.↑
Song SJ, Bae JK, Park CH, Yoo MC, Bae DK, & Kim KI. Mid-term outcomes and complications of total knee arthroplasty in haemophilic arthropathy: a review of consecutive 131 knees between 2006 and 2015 in a single institute. Haemophilia 2018 24 299–306. (https://doi.org/10.1111/hae.13383)
- 44.↑
Rodríguez-Merchán EC. Total knee arthroplasty using hinge joints: indications and results. EFORT Open Reviews 2019 4 121–132. (https://doi.org/10.1302/2058-5241.4.180056)
- 45.↑
Rivière C, Webb J, & Vendittoli PA. Kinematic alignment technique for TKA on degenerative knees with severe bone loss: a report of 3 cases. Open Orthopaedics Journal 2021 15 27–34. (https://doi.org/10.2174/1874325002115010027)
- 46.↑
Rivière C, Jackson W, Villet L, Sivaloganathan S, Barziv Y, & Vendittoli PA. Specific case consideration for implanting TKA with the Kinematic Alignment technique. EFORT Open Reviews 2021 6 881–891. (https://doi.org/10.1302/2058-5241.6.210042)
- 47.↑
Grela M, Barrett M, Kunutsor SK, Blom AW, Whitehouse MR, & Matharu GS. Clinical effectiveness of patellar resurfacing, no resurfacing and selective resurfacing in primary total knee replacement: systematic review and meta-analysis of interventional and observational evidence. BMC Musculoskeletal Disorders 2022 23 932. (https://doi.org/10.1186/s12891-022-05877-7)
- 48.↑
Solimeno LP, & Pasta G. Knee and ankle arthroplasty in hemophilia. Journal of Clinical Medicine 2017 6 107. (https://doi.org/10.3390/jcm6110107)
- 49.↑
Mercurio M, Gasparini G, Sanzo V, Familiari F, Castioni D, & Galasso O. Cemented total knee arthroplasty shows less blood loss but a higher rate of aseptic loosening compared with cementless fixation: an updated meta-analysis of comparative studies. Journal of Arthroplasty 2022 37 1879–1887.e4. (https://doi.org/10.1016/j.arth.2022.04.013)
- 50.↑
Xu X, Zhang X, Zhang Y, Chen C, Yu H, & Xue E. Role of intra-wound powdered vancomycin in primary total knee arthroplasty. Orthopaedics and Traumatology, Surgery and Research 2020 106 417–420. (https://doi.org/10.1016/j.otsr.2020.01.007)
- 51.↑
Wong MT, Sridharan SS, Davison EM, Ng R, & Desy NM. Can topical vancomycin prevent periprosthetic joint infection in hip and knee arthroplasty? A systematic review. Clinical Orthopaedics and Related Research 2021 479 1655–1664. (https://doi.org/10.1097/CORR.0000000000001777)
- 52.↑
Shen SN, Wu DX, Lv SJ, & Tong PJ. Hidden blood loss of total knee arthroplasty in hemophilia arthritis: an analysis of influencing factors. BMC Musculoskeletal Disorders 2022 23 587. (https://doi.org/10.1186/s12891-022-05535-y)
- 53.↑
Moore MF, Tobase P, & Allen DD. Meta-analysis: outcomes of total knee arthroplasty in the haemophilia population. Haemophilia 2016 22 e275–e285. (https://doi.org/10.1111/hae.12885)
- 54.↑
Pathak N, Munger AM, Charifa A, Laskin WB, Bisson E, Kupfer GM, & Rubin LE. Total knee arthroplasty in hemophilia A. Arthroplasty Today 2020 6 52–58.e1. (https://doi.org/10.1016/j.artd.2019.12.008)
- 55.↑
Mortazavi SMJ, Firoozabadi MA, Najafi A, & Mansouri P. Evaluation of outcomes of suction drainage in patients with haemophilic arthropathy undergoing total knee arthroplasty. Haemophilia 2017 23 e310–e315. (https://doi.org/10.1111/hae.13224)
- 56.↑
Tang Q, Shang P, Zheng G, Xu HZ, & Liu HX. Extramedullary versus intramedullary femoral alignment technique in total knee arthroplasty: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research 2017 12 82. (https://doi.org/10.1186/s13018-017-0582-3)
- 57.↑
Karachalios T, & Komnos GA. Individualized surgery in primary total knee arthroplasty. EFORT Open Reviews 2020 5 663–671. (https://doi.org/10.1302/2058-5241.5.190085)
- 58.↑
Rivière C, Lazic S, Boughton O, Wiart Y, Vïllet L, & Cobb J. Current concepts for aligning knee implants: patient-specific or systematic? EFORT Open Reviews 2018 3 1–6. (https://doi.org/10.1302/2058-5241.3.170021)
- 59.↑
Richter M, Trzeciak T, & Kaczmarek M. Effect of continuous passive motion on the early recovery outcomes after total knee arthroplasty. International Orthopaedics 2022 46 549–553. (https://doi.org/10.1007/s00264-021-05245-5)
- 60.↑
Brosseau L, Milne S, Wells G, Tugwell P, Robinson V, Casimiro L, Pelland L, Noel MJ, Davis J, & Drouin H. Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. Journal of Rheumatology 2004 31 2251–2264.
- 61.↑
Waterson HB, Clement ND, Eyres KS, Mandalia VI, & Toms AD. The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: a prospective randomised control trial. Bone and Joint Journal 2016 98–B 1360–1368. (https://doi.org/10.1302/0301-620X.98B10.36862)
- 62.↑
Goddard NJ, Mann HA, & Lee CA. Total knee replacement in patients with end-stage haemophilic arthropathy. Journal of Bone and Joint Surgery. (British Volume) 2010 92-B 1085–1089. (https://doi.org/10.1302/0301-620X.92B8.23922)
- 63.↑
Silva M, & Luck v JV. Long-term results of primary total knee replacement in patients with hemophilia. Journal of Bone and Joint Surgery. American Volume 2005 87 85–91. (https://doi.org/10.2106/JBJS.C.01609)
- 64.↑
Carulli C, Innocenti M, Linari S, Morfini M, Castaman G, & Innocenti M. Joint replacement for the management of haemophilic arthropathy in patients with inhibitors: a long-term experience at a single Haemophilia centre. Haemophilia 2021 27 e93–e101. (https://doi.org/10.1111/hae.14169)
- 65.↑
Wang R, Wang Z, Gu Y, Zhang J, Wang P, Tong P, & Lv S. Total knee arthroplasty in patients with haemophilic arthropathy is effective and safe according to the outcomes at a mid-term follow-up. Journal of Orthopaedics and Traumatology 2022 23 31. (https://doi.org/10.1186/s10195-022-00648-5)
- 66.↑
Westberg M, Paus AC, Holme PA, & Tjønnfjord GE. Haemophilic arthropathy: long-term outcomes in 107 primary total knee arthroplasties. Knee 2014 21 147–150. (https://doi.org/10.1016/j.knee.2013.09.010)
- 67.↑
Norian JM, Ries MD, Karp S, & Hambleton J. Total knee arthroplasty in hemophilic arthropathy. Journal of Bone and Joint Surgery. American Volume 2002 84 1138–1141. (https://doi.org/10.2106/00004623-200207000-00007)
- 68.↑
Khaw FM, Kirk LMG, & Gregg PJ. Survival analysis of cemented Press-Fit Condylar total knee arthroplasty. Journal of Arthroplasty 2001 16 161–167. (https://doi.org/10.1054/arth.2001.20254)
- 69.↑
Aglietti P, Buzzi R, de Felice R, & Giron F. The insall-Burstein total knee replacement in osteoarthritis: a 10-year minimum follow-up. Journal of Arthroplasty 1999 14 560–565. (https://doi.org/10.1016/s0883-5403(9990077-3)
- 70.↑
Duffy GP, Crowder AR, Trousdale RR, & Berry DJ. Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis. Journal of Arthroplasty 2007 22(6) 67–70. (https://doi.org/10.1016/j.arth.2007.05.001)
- 71.↑
Rodríguez-Merchán EC. Total knee arthroplasty in hemophilic arthropathy. American Journal of Orthopedics 2015 44 E503–E507.
- 72.↑
Ernstbrunner L, Hingsammer A, Catanzaro S, Sutter R, Brand B, Wieser K, & Fucentese SF. Long-term results of total knee arthroplasty in haemophilic patients: an 18-year follow-up. Knee Surgery, Sports Traumatology, Arthroscopy 2017 25 3431–3438. (https://doi.org/10.1007/s00167-016-4340-6)
- 73.↑
Li Z, Feng B, Du Y, Wang Y, Bian Y, & Weng X. Complications of total knee arthroplasty in patients with haemophilia compared with osteoarthritis and rheumatoid arthritis: a 20-year single-surgeon cohort. Haemophilia 2020 26 861–866. (https://doi.org/10.1111/hae.14115)
- 74.↑
Goker B, Caglar O, Kinikli GI, Aksu S, Tokgozoglu AM, & Atilla B. Postoperative bleeding adversely affects total knee arthroplasty outcomes in hemophilia. Knee 2022 39 261–268. (https://doi.org/10.1016/j.knee.2022.10.001)
- 75.↑
Powell DL, Whitener CJ, Dye CE, Ballard JO, Shaffer ML, & Eyster ME. Knee and hip arthroplasty infection rates in persons with haemophilia: a 27 year single center experience during the HIV epidemic. Haemophilia 2005 11 233–239. (https://doi.org/10.1111/j.1365-2516.2005.01081.x)
- 76.↑
Cancienne JM, Werner BC, & Browne JA. Complications after TKA in patients with hemophilia or von Willebrand’s disease. Journal of Arthroplasty 2015 30 2285–2289. (https://doi.org/10.1016/j.arth.2015.06.015)
- 77.↑
Wong JML, Mann HA, & Goddard NJ. Perioperative clotting factor replacement and infection in total knee arthroplasty. Haemophilia 2012 18 607–612. (https://doi.org/10.1111/j.1365-2516.2011.02728.x)
- 78.↑
Rahmé M, Ehlinger M, Faradji A, Gengenwin N, Lecocq J, Sibilia J, & Bonnomet F. Total knee arthroplasty in severe haemophilic patients under continuous infusion of clotting factors. Knee Surgery, Sports Traumatology, Arthroscopy 2012 20 1781–1786. (https://doi.org/10.1007/s00167-011-1766-8)
- 79.↑
Huang ZY, Huang Q, Zeng HJ, Ma J, Shen B, Zhou ZK, & Pei FX. Tranexamic acid may benefit patients undergoing total hip/knee arthroplasty because of haemophilia. BMC Musculoskeletal Disorders 2019 20 402. (https://doi.org/10.1186/s12891-019-2767-x)
- 80.↑
Rodriguez-Merchan EC, Encinas-Ullan CA, & Gomez-Cardero P. Intra-articular tranexamic acid in primary total knee arthroplasty decreases the rate of post-operative blood transfusions in people with hemophilia: a retrospective case-control study. HSS Journal 2020 16 218–221. (https://doi.org/10.1007/s11420-019-09711-0)
- 81.↑
Perez Botero J, Spoon DB, Patnaik MS, Ashrani AA, Trousdale RT, & Pruthi RK. Incidence of symptomatic venous thromboembolism in patients with hemophilia undergoing joint replacement surgery: a retrospective study. Thrombosis Research 2015 135 109–113. (https://doi.org/10.1016/j.thromres.2014.11.010)
- 82.↑
Peng HM, Wang LC, Zhai JL, Jiang C, Weng XS, Feng B, & Gao N. Incidence of symptomatic venous thromboembolism in patients with hemophilia undergoing hip and knee joint replacement without chemoprophylaxis: a retrospective study. Orthopaedic Surgery 2019 11 236–240. (https://doi.org/10.1111/os.12444)
- 83.↑
Holderness BM, Goto Y, McKernan L, Bernini P, & Ornstein DL. Thromboprophylaxis and outcomes for total joint arthroplasty in congenital bleeding disorders: a Single-Center Experience. Clinical and Applied Thrombosis/Hemostasis 2016 22 563–568. (https://doi.org/10.1177/1076029616643821)
- 84.↑
Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, & Colwell CW. Prevention of VTE in orthopedic surgery patients: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012 141(Z2) e278S–e325S. (https://doi.org/10.1378/chest.11-2404)
- 85.↑
Pulido L, Ghanem E, Joshi A, Purtill JJ, & Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clinical Orthopaedics and Related Research 2008 466 1710–1715. (https://doi.org/10.1007/s11999-008-0209-4)
- 86.↑
Hasenauer MD, Ho H, Engh CA, & Engh CA. Factors associated with the incidence and timing of total knee arthroplasty infection. Journal of Arthroplasty 2022 37 S276–S280.e3. (https://doi.org/10.1016/j.arth.2022.02.034)
- 87.↑
Rodriquez-Merchan EC, Gomez-Cardero P, & Jimenez-Yuste V. Infection after total knee arthroplasty in haemophilic arthropathy with special emphasis on late infection. Haemophilia 2011. (https://doi.org/10.1111/j.1365-2516.2011.02530.x)
- 88.↑
Hicks JL, Ribbans WJ, Buzzard B, Kelley SS, Toft L, Torri G, Wiedel JD, & York J. Infected joint replacements in HIV-positive patients with haemophilia. Journal of Bone and Joint Surgery. British Volume 2001 83 1050–1054. (https://doi.org/10.1302/0301-620x.83b7.11242)
- 89.↑
Ragni v. M, Crossett LS, & Herndon JH. Postoperative infection following orthopaedic surgery in human immunodeficiency virus-infected hemophiliacs with CD4 counts ≤ 200/mm3. Journal of Arthroplasty 1995 10 716–721.
- 90.↑
Mortazavi SMJ, Haghpanah B, Ebrahiminasab MM, Baghdadi T, Hantooshzadeh R, & Toogeh G. Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost-effective procedure? Haemophilia 2016 22 303–307. (https://doi.org/10.1111/hae.12832)
- 91.↑
Thès A, Molina V, & Lambert T. Simultaneous bilateral total knee arthroplasty in severe hemophilia: a retrospective cost-effectiveness analysis. Orthopaedics and Traumatology, Surgery and Research 2015 101 147–150. (https://doi.org/10.1016/j.otsr.2014.12.010)
- 92.↑
Jiang C, Zhao Y, Feng B, Zhai J, Bian Y, Qiu G, & Weng X. Simultaneous bilateral total knee arthroplasty in patients with end-stage hemophilic arthropathy: a mean follow-up of 6 years. Scientific Reports 2018 8 1608. (https://doi.org/10.1038/s41598-018-19852-7)
- 93.↑
Odum SM, Troyer JL, Kelly MP, Dedini RD, & Bozic KJ. A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. Journal of Bone and Joint Surgery. American Volume 2013 95 1441–1449. (https://doi.org/10.2106/JBJS.L.00373)
- 94.↑
Reuben JD, Meyers SJ, Cox DD, Elliott M, Watson M, & Shim SD. Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. Journal of Arthroplasty 1998 13 172–179. (https://doi.org/10.1016/s0883-5403(9890095-x)
- 95.↑
Alghadir AH, Iqbal ZA, Anwer S, & Anwar D. Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery. BMC Musculoskeletal Disorders 2020 21 246. (https://doi.org/10.1186/s12891-020-03269-3)
- 96.↑
Teng WN, Su YP, Kuo IT, Lin SM, Tsou MY, Chan KH, & Ting CK. Patient controlled epidural analgesia for bilateral versus unilateral total knee arthroplasty: a retrospective study of pain control. Journal of the Chinese Medical Association 2012 75 114–120. (https://doi.org/10.1016/j.jcma.2012.02.002)