The Journal of Bone and Joint Surgery (American) 84:1138-1141 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Total Knee Arthroplasty in Hemophilic Arthropathy
John M. Norian, BS,
Michael D. Ries, MD,
Susan Karp, RN and
Julie Hambleton, MD
Investigation performed at the University of California,
San Francisco, San Francisco, California
John M. Norian, BS
Royal College of Surgeons, Ireland, Dublin 2, Ireland
Michael D. Ries, MD
Department of Orthopaedic Surgery, University of California San
Francisco Medical Center, 500 Parnassus Avenue, MU-320-West, San
Francisco, CA 94143-0728
Susan Karp, RN
Julie Hambleton, MD
Department of Medicine, University of California San Francisco
Medical Center, 500 Parnassus Avenue, M1286, San Francisco, CA 94143-0728
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. They did not
receive payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other
charitable or nonprofit organization with which the authors are
affiliated or associated.
Background:
Arthropathy of the knee frequently develops in patients with hemophilia,
who may require a total knee arthroplasty at a young age. Hemophilic
patients, who require regular intravenous replacement of coagulation
factor, have a higher prevalence of human immunodeficiency virus
(HIV) infection, which can compromise the outcome of the arthroplasty.
The purpose of this study was to evaluate prosthetic survival following
total knee arthroplasty and identify factors associated with failures
of the arthroplasties in hemophilic patients.
Methods:
The results of fifty-three total knee arthroplasties performed in
thirty-eight patients (twenty-nine of whom were seropositive for
HIV) to treat hemophilic arthropathy between 1976 and 1998 were
retrospectively reviewed. Inpatient and outpatient medical records
were studied to determine the HIV status, CD4 lymphocyte count,
type of prosthesis, duration of prosthetic survival, cause of failure,
and cause of death. If an arthroplasty failed, the outcome of the
treatment of the failed arthroplasty was also determined.
Results:
The rate of survival of the prostheses was 90% after five years.
Eleven total knee arthroplasties failed. The most common cause of
failure was infection (seven knees), which developed at an average
of sixty months (range, three to 138 months) after the arthroplasty.
There was no significant difference in the CD4 lymphocyte counts
between the patients in whom infection developed and those in whom
it did not. The HIV status also did not appear to be related to
the development of infection. Thirteen patients died, and the most
common cause of death was complications associated with acquired
immunodeficiency syndrome (AIDS).
Conclusions:
Total knee arthroplasty performed to treat hemophilic arthropathy
has a high risk of failure as a result of infection. Most infections
developed late and were frequently caused by Staphylococcus epidermidis,
suggesting that a likely cause of failure due to infection was hematogenous
spread during administration of coagulation factor. It may be difficult
to salvage a prosthesis complicated by infection. However, the life expectancy
of hemophilic patients is lower than that of the general population
of patients treated with total knee arthroplasty, and the improvement
in the quality of life after total knee arthroplasty for hemophilic
arthropathy may outweigh the risk of failure.
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