Knee arthroplasty in hemophilic arthropathy

Twenty-three total knee arthroplasties in 15 patients with severe hemophili a were performed between February 1974 and September 1988, Thirteen patient s had Factor VIII deficiency and two had Factor IX deficiency. The mean fol lowup period was 7.5 years, with a minimum of 4 years for patients who were alive (eight) at the time of this review Seven patients had died before th is report, and all were seropositive for the human immunodeficiency virus. Using the Hospital for Special Surgery knee scoring system, the result was excellent in one knee, good in three, fair in two, and poor in 17. One pati ent was seropositive for the human immunodeficiency virus at the time of th e index procedure, and 12 were seropositive at the most recent followup; th e human immunodeficiency status of three patients was unknown. There were t wo early and two late deep infections, all in patients who were seropositiv e for the human immunodeficiency virus. The most recent postoperative radio graphs for all knees were reviewed using the Knee Society radiographic scor ing system. Ten femoral components were well fixed, 11 were possibly loose, and two were probably loose, Eight tibial components were well fixed, 10 p ossibly loose, three probably loose, and two definitely loose. One knee had been revised for aseptic loosening. There are few published studies of the long term results of total knee arthroplasties in patients with hemophilia . In this series of 23 knees, there was a high rate of loosening and infect ion. Total knee arthroplasty may be a useful treatment for the relief of pa in attributable to end stage hemophilic arthropathy, but there is a high ra te of complications, especially in patients who are seropositive for the hu man immunodeficiency virus.