Haemophilia is an inherited blood disorder which causes the person’s blood to fail to clot properly. Blood normally contains proteins – called clotting factors – that help to stop bleeding. However, in people with haemophilia, the factor VIII and factor IX proteins are very low which can lead to spontaneous or prolonged bleeding following an injury or surgery. The lower the levels of clotting factors, the greater the risk of serious health problems.
What is haemophilia?
Haemophilia is normally an inherited condition caused by a genetic mutation. Rarely, it can develop later in life mostly among middle-aged or older people or women in the latter stages of pregnancy.
Haemophilic arthropathy
One of the complications associated with haemophilia is haemophilic arthropathy. This is permanent and irreversible joint damage caused by repeated bleeding into the same joint which results in damage to the cartilage and joint lining. Haemophilic arthropathy is a degenerative condition which worsens over time. Symptoms, including pain and loss of mobility, normally appear later in life so it is important to monitor joint bleeds carefully if you have haemophilia. Regular treatment with a clotting factor can help you to keep your joints and muscles healthy for longer.
Study into total knee replacements for haemophilic arthroplasty
Severe haemophilic arthropathy cannot be reversed and the normal treatment is joint replacement surgery. A recent study, published in The Journal of Arthroplasty, looked at total knee replacements in patients with haemophilic arthroplasty. Researchers from hospitals in Ireland, including St James’s and Cork University Hospital and the Health Research Board Clinical Research Facility at the National University of Ireland in Galway, looked at the outcomes of patients with haemophilia undergoing total knee replacement surgery.
Methodology
The research team looked at a range of measures including patient-reported functional outcomes, how well the prosthetic implant survived and any complications following surgery. Twenty-eight studies were examined, with a total of 1210 total knee replacements in 917 patients with haemophilic arthropathy. The average age of patients was 38.5 years and the average length of follow up was 7.1 years.
Findings
The study showed that 28.7% of patients experienced complications and 19.3% of them needed a further procedure. The most common complication reported was post-operative hemarthrosis, which is bleeding into the joint which causes pain and swelling and excessive bruising. It may require surgery. Deep infection and aseptic loosening were also noted, although procedures performed after 2000 showed a decrease compared to those carried out before this date.
The researchers found a 44.6 point improvement in the Hospital for Special Surgery Knee Score and knee function improved by 35.9 points according to the Knee Society Score. Overall, total range of motion improved by 22.3%.
Conclusions
They concluded that total knee replacement surgery is a successful procedure in patients with haemophilic arthropathy. It can improve function, reduce pain and increase range of motion. Patients having the procedure at a younger age have a greater risk of complications than older patients, however modern surgical techniques have lowered this risk. Survival rates for the prosthetic implants are similar to other sectors of the population.
If you are experiencing knee pain, loss of movement and declining quality of life as a result of haemophilic arthropathy, talk to us about the pros and cons of total knee replacement surgery.
