Orthopaedic outcome of total knee replacement in Haemophilia A

A consecutive series of 16 patients with classical Haemophilia underwent 21 total knee replacements between 1989 and 1997 for haemophilic arthropathy. The patients received Factor VIII replacement therapy via continuous infus ion, and fibrin glue was used to facilitate haemostasis. Three different ty pes of prostheses were used. A follow-up evaluation was undertaken between 2 and 10 years after the operation (mean 5.6 years) and two patients with i nfection were excluded. Knee scores averaged 77.5 (pre-operative 24.1) and functional scores averaged 84.4 (preoperative 23.2). There were no cases wi th aseptic loosening of the prosthesis. Complications included one early de ep infection controlled by conversion of the TKR into an arthrodesis, one c ase of late septic loosening that had to be re-operated upon, one case of p atellar dislocation, two cases of stiff knee (fibro-arthrosis) that require d manipulation under anaesthesia, one postoperative hepatitis, one superfic ial infection treated by incision and drainage and four febrile patients wi th no clear source of infection, who responded to antibiotics alone. In con clusion, TKR offers haemophilic patients a long-lasting improvement of thei r quality of life and we therefore advocate its use with the appropriate in dications.