The Journal of Bone and Joint Surgery (American). 2005;87:85-91.
doi:10.2106/JBJS.C.01609
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Silva, M.
Right arrow Articles by Luck, J. V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Silva, M.
Right arrow Articles by Luck, J. V., Jr.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Long-Term Results of Primary Total Knee Replacement in Patients with Hemophilia

Mauricio Silva, MD1 and James V. Luck, Jr., MD1

1 Hemophilia Treatment Center, Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007. E-mail address for M. Silva: msilva{at}laoh.ucla.edu

Investigation performed at Hemophilia Treatment Center, Orthopaedic Hospital, Los Angeles, California

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.

NOTE: The authors thank Laurence Logan, MD, Victor Marder, MD, and Fred J. Dorey, PhD, for their contributions to the present study.

Background: The outcome of total knee replacement in patients with hemophilia has been variable. Several authors have suggested a relationship between high rates of late infection following total knee replacement in patients with hemophilia and a positive HIV status. The objective of this study was to evaluate the results of primary total knee replacements performed in a large group of hemophilic patients at a single institution by the same primary surgeon.

Methods: The results of ninety primary total knee replacements performed in sixty-eight hemophilic patients between 1975 and 2001 were reviewed retrospectively. The HIV status and the CD4 count at the time of the surgery were recorded for fifty-three patients (seventy-one knees). Knee Society clinical and functional scores were determined for twenty-nine patients (thirty-eight knees) who were available for follow-up. Prosthetic survival was calculated with use of Kaplan-Meier survivorship analysis.

Results: The overall prevalence of infection was 16%. Twelve knees required removal of components, and the reason for the removal was late infection in nine of them. The prevalence of infection in HIV-positive and HIV-negative patients was 17% and 13%, respectively (p = 0.5). When component removal for any reason, survival free of infection at any point, and mechanical failure were considered to be the end points, the ten-year survival rates were 83%, 77%, and 96%, respectively. The Knee Society clinical score was excellent or good for 80% of the knees, and the Knee Society functional score was excellent or good for 97% of the knees.

Conclusions: Despite the anatomical challenges, the mechanical survival of total knee replacements in patients with hemophilia is quite good. However, the prevalence of infection after the total knee replacements was high. The prevention of late infection would substantially improve the long-term outcome of total knee replacements in this patient population.

Level of Evidence: Therapeutic study, Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
D. D. Galat, S. C. McGovern, A. D. Hanssen, D. R. Larson, J. R. Harrington, and H. D. Clarke
Early Return to Surgery for Evacuation of a Postoperative Hematoma After Primary Total Knee Arthroplasty
J. Bone Joint Surg. Am., November 1, 2008; 90(11): 2331 - 2336.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
W. A. Jiranek, A. D. Hanssen, and A. S. Greenwald
Antibiotic-Loaded Bone Cement for Infection Prophylaxis in Total Joint Replacement
J. Bone Joint Surg. Am., November 1, 2006; 88(11): 2487 - 2500.
[Abstract] [Full Text] [PDF]