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The Journal of Bone and Joint Surgery (American). 2004;86:2519-2521
© 2004 The Journal of Bone and Joint Surgery, Inc.

Total Knee Arthroplasty Using Recombinant Factor VII in Hemophilia-A Patients with Inhibitors

A Report of Three Cases

Samir Mehta, MD1, Charles L. Nelson, MD1, Barbara A. Konkle, MD2 and Brian Vannozzi, MD1

1 Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104. E-mail address for C. Nelson: charles.nelson@uphs.upenn.edu
2 Department of Medicine, Penn Comprehensive Hemophilia and Thrombosis Program, University of Pennsylvania School of Medicine, 38th and Market Streets, Philadelphia, PA 19104

Investigation performed at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

The first 150 words of the full text of this article appear below.


   Introduction
 
Elective orthopaedic surgery, including total joint arthroplasty, has become a safe and effective therapeutic option for most patients with hemophilic arthropathy and has been reported to reduce the rate of hemarthrosis and the clinical consequence of severe joint damage1. However, the 10% to 30% of patients with severe hemophilia who have development of neutralizing antibodies (inhibitors) to factor VIII (FVIII) or factor IX (FIX) do not fare as well2. The development of an inhibitor is one of the most serious complications associated with hemophilia because inhibitors may neutralize clotting factor concentrates. Patients with inhibitors often have substantially worse joint function secondary to inadequate treatment and traditionally have not been candidates for elective joint replacement surgery3. The orthopaedic literature regarding total knee arthroplasty in patients with hemophilia is limited, with little emphasis on patients with inhibitors4-9. Previous studies of total knee arthroplasty in patients with inhibitors, involving . . . [Full Text of this Article]


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Letters to the Editor:

Read all Letters to the Editor

Orthopaedic surgery in a patient with inhibitors
Joannis Panotopoulos, et al.
JBJS Online, 29 Nov 2004 [Full text]
Dr. Nelson responds to Drs. Panotopoulos and Trieb
Charles L Nelson, et al.
JBJS Online, 2 Dec 2004 [Full text]
Total Knee Arthroplasty in Hemophilic Patients with Inhibitors Using rFVIIa.
E. Carlos Rodriguez-Merchan, M.D., Ph.D.
JBJS Online, 13 Jan 2005 [Full text]