BACKGROUND: Outcomes of total knee replacement in cases of hemophilic patients are worse than in patients who undergo operations due to osteoarthritis. Previous publications have reported varying rates of complications in hemophilic patients, such as infection and an unsatisfactory range of motion, which have influenced the survival of prostheses. Our retrospective study evaluated the data of hemophilic patients regarding changes in the development of the range of motion. METHODS: The data and clinical outcomes of 72 total knee replacements in 45 patients with hemophilia types A and B were reviewed retrospectively. Patients were operated between 1998 and 2013. All of the patients were systematically followed up to record the range of motion and other parameters before and after surgery. RESULTS: The mean preoperative flexion contracture was 17° ± 11° (range, 0°-40°), and it was 7° ± 12° (range, 0°-60°) postoperatively. The mean flexion of the knee was 73° ± 30° (range, 5°-135°) before the operation and 80° ± 19° (range, 30°-110°) at the last follow-up. The mean range of motion was 56° ± 34° (range, 0°-130°) before the operation and 73° ± 24° (range, 10°-110°) at the last follow-up. CONCLUSIONS: Statistical analysis suggested that the range of motion could be improved until the 9th postoperative week. The patient should be operated on until the flexion contracture reaches 22° to obtain a contracture < 15° postoperatively or until the contracture reaches 12° to obtain less than 5°. The operation generally does not change the flexion of the knee in cases of hemophilic patients, but it reduces the flexion contracture and therefore improves the range.

Department of Orthopaedics 1st Faculty of Medicine Charles University and Motol University Hospital Úvalu 84 15006 Prague 5 Czech Republic

Department of Orthopaedics 1st Faculty of Medicine Charles University and Na Bulovce Hospital Budínova 2 180 81 Prague 8 Czech Republic

Department of Social and Clinical Pharmacy Faculty of Pharmacy Charles University Akademika Heyrovského 1203 500 05 Hradec Králové Czech Republic

Institute of Clinical and Experimental Hematology 1st Faculty of Medicine Charles University and Institute of Hematology and Blood Transfusion U Nemocnice 1 12802 Prague 2 Czech Republic

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Goddard NJ, Mann HA, Lee CA. Total knee replacement in patients with end-stage haemophilic arthropathy: 25-year results. J Bone Joint Surg Br. 2010;92:1085–1089. doi: 10.1302/0301-620X.92B8.23922. PubMed DOI

Norian JM, Ries MD, Karp S, Hambleton J. Total knee arthroplasty in hemophilic arthropathy. J Bone Joint Surg Am. 2002;84-A:1138–1141. doi: 10.2106/00004623-200207000-00007. PubMed DOI

Hicks JL, Ribbans WJ, Buzzard B, Kelley SS, Toft L, Torri G, et al. Infected joint replacements in HIV-positive patients with haemophilia. J Bone Joint Surg Br. 2001;83:1050–1054. doi: 10.1302/0301-620X.83B7.11242. PubMed DOI

Chiang CC, Chen PQ, Shen MC, Tsai W. Total knee arthroplasty for severe haemophilic arthropathy: long-term experience in Taiwan. Haemophilia. 2008;14:828–834. doi: 10.1111/j.1365-2516.2008.01693.x. PubMed DOI

Sikkema T, Boerboom AL, Meijer KA. Comparison between the complications and long-term outcome of hip and knee replacement therapy in patients with and without haemophilia; a controlled retrospective cohort study. Haemophilia. 2011;17:300–303. doi: 10.1111/j.1365-2516.2010.02408.x. PubMed DOI

Cohen I, Heim M, Martinowitz U, Chechick A. Orthopaedic outcome of total knee replacement in haemophilia a. Haemophilia. 2000;6(2):104–109. doi: 10.1046/j.1365-2516.2000.00375.x. PubMed DOI

Chevalier Y, Dargaud Y, Lienhart A, Chamouard V, Negrier C. Seventy-two total knee arthroplasties performed in patients with haemophilia using continuous infusion. Vox Sang. 2013;104(2):135–143. doi: 10.1111/j.1423-0410.2012.01653.x. PubMed DOI

Panotopoulos J, Ay C, Trieb K, Schuh R, Windhager R, Wanivenhaus HA. Outcome of total knee arthroplasty in hemophilic arthropathy. J Arthroplast. 2014;29(4):749–752. doi: 10.1016/j.arth.2013.07.014. PubMed DOI

Westberg M, Paus AC, Holme PA, Tjonnfjord GE. Haemophilic arthropathy: long-term outcomes in 107 primary total knee arthroplasties. Knee. 2014;21(1):147–150. doi: 10.1016/j.knee.2013.09.010. PubMed DOI

Song SJ, Bae JK, Park CH, Yoo MC, Bae DK, Kim KI. Mid-term outcomes and complications of total knee arthroplasty in haemophilic arthropathy: a review of consecutive 131 knees between 2006 and 2015 in a single institute. Haemophilia. 2017; PubMed

Ernstbrunner L, Hingsammer A, Catanzaro S, Sutter R, Brand B, Wieser K, Fucentese SF. Long-term results of total knee arthroplasty in haemophilic patients: an 18-year follow-up. Knee Surg Sport Tr A. 2017;25(11):3431–3438. doi: 10.1007/s00167-016-4340-6. PubMed DOI

Mortazavi SM, Haghpanah B, Ebrahiminasab MM, Baghdadi T, Toogeh G. Functional outcome of total knee arthroplasty in patients with haemophilia. Haemophilia. 2016;22(6):919–924. doi: 10.1111/hae.12999. PubMed DOI

Atilla B, Caglar O, Pekmezci M, Buyukasik Y, Tokgozoglu AM, Alpaslan M. Pre-operative flexion contracture determines the functional outcome of haemophilic arthropathy treated with total knee arthroplasty. Haemophilia. 2012;18:358–363. doi: 10.1111/j.1365-2516.2011.02695.x. PubMed DOI

Rodriguez-Merchan EC. Total knee replacement in haemophilic arthropathy. J Bone Joint Surg Br. 2007;89:186–188. doi: 10.1302/0301-620X.89B2.18682. PubMed DOI

White GC, 2nd, Rosendaal F, Aledort LM, Lusher JM, Rothschild C, Ingerslev J, et al. Definitions in hemophilia. Recommendation of the scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the international society on thrombosis and Haemostasis. Throm Haemostasis 2001; 85: 560. PubMed

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat R 1989: 13–14. PubMed

Healy WL, Della Valle CJ, Iorio R, Berend KR, Cushner FD, Dalury DF, et al. Complications of total knee arthroplasty: standardized list and definitions of the knee society. Clin Orthop Relat R. 2013;471:215–220. doi: 10.1007/s11999-012-2489-y. PubMed DOI PMC

Bae DK, Yoon KH, Kim HS, Song SJ. Total knee arthroplasty in hemophilic arthropathy of the knee. J Arthroplast. 2005;20:664–668. doi: 10.1016/j.arth.2005.01.008. PubMed DOI

Goddard NJ, Rodriguez-Merchan EC, Wiedel JD. Total knee replacement in haemophilia. Haemophilia. 2002;8:382–386. doi: 10.1046/j.1365-2516.2002.00604.x. PubMed DOI

Silva M, Luck JV, Jr. Long-term results of primary total knee replacement in patients with hemophilia. J Bone Joint Surg Am 2005; 87: 85–91. PubMed

Kagaya H, Ito S, Iwami T, Obinata G, Shimada Y. A computer simulation of human walking in persons with joint contractures. Tohoku J Exp Med. 2003;200:31–37. doi: 10.1620/tjem.200.31. PubMed DOI