Evidence-based management of the knee in hemophilia
File(s)
Accepted version
Author(s)
Liddle, Alexander D
Carlos Rodriguez-Merchan, E
Type
Journal Article
Abstract
» Hemophilia is among the commonest bleeding disorders
encountered in orthopaedic practice and results from an Xchromosome-linked failure of coagulation factors VIII (hemophilia A) or
IX (hemophilia B).
» Morbidity in hemophilia is a result of repeated hemarthroses, and the
aim of orthopaedic management is to prevent these, to treat them
promptly, and to address the joint pathology that results.
» Both radiosynovectomy and arthroscopic synovectomy are effective
in reducing the degree of synovitis and the number of hemarthroses,
although, to our knowledge, there is little evidence that it prevents
progression to end-stage arthritis. There is substantial evidence for the
safety and effectiveness of radiosynovectomy, and this is the first line
of treatment in our practice.
» In end-stage disease, total knee arthroplasty is challenging as a result
of severe contractures and is associated with a higher rate of
complications such as infection (7% compared with 1% to 2% in
osteoarthritis) and need for blood transfusions and a higher revision
rate than that seen in total knee arthroplasty for osteoarthritis.
» However, many series of total knee arthroplasty for hemophilia have
now been published, and excellent results can be gained in terms of
pain relief and quality of life.
encountered in orthopaedic practice and results from an Xchromosome-linked failure of coagulation factors VIII (hemophilia A) or
IX (hemophilia B).
» Morbidity in hemophilia is a result of repeated hemarthroses, and the
aim of orthopaedic management is to prevent these, to treat them
promptly, and to address the joint pathology that results.
» Both radiosynovectomy and arthroscopic synovectomy are effective
in reducing the degree of synovitis and the number of hemarthroses,
although, to our knowledge, there is little evidence that it prevents
progression to end-stage arthritis. There is substantial evidence for the
safety and effectiveness of radiosynovectomy, and this is the first line
of treatment in our practice.
» In end-stage disease, total knee arthroplasty is challenging as a result
of severe contractures and is associated with a higher rate of
complications such as infection (7% compared with 1% to 2% in
osteoarthritis) and need for blood transfusions and a higher revision
rate than that seen in total knee arthroplasty for osteoarthritis.
» However, many series of total knee arthroplasty for hemophilia have
now been published, and excellent results can be gained in terms of
pain relief and quality of life.
Date Issued
2017-08-01
Date Acceptance
2017-08-01
Citation
JBJS Reviews, 2017, 5 (8)
ISSN
2329-9185
Publisher
Lippincott, Williams & Wilkins
Journal / Book Title
JBJS Reviews
Volume
5
Issue
8
Copyright Statement
© 2017 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED This is a non-final version of an article published in final form at https://dx.doi.org/10.2106/JBJS.RVW.16.00100
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000411343500012&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
ARTHROSCOPIC SYNOVECTOMY
FLEXION CONTRACTURE
FACTOR-VIII
SURGICAL SYNOVECTOMY
ORTHOPEDIC-SURGERY
ACUTE HEMARTHROSIS
JOINT REPLACEMENT
FOLLOW-UP
ARTHROPATHY
ARTHROPLASTY
Publication Status
Published
Article Number
ARTN e12
Date Publish Online
2017-08-01