Knee joint arthroplasty in a patient with haemophilia A and high inhibitortitre using recombinant factor VIIa (NovoSeven((R))): a new case report and review of the literature

Elective orthopaedic surgery is regularly withheld from patients with haemo philia and high inhibitor titre despite the presence of severe arthropathy and urgent medical need. A knee joint arthroplasty was performed in a patie nt with severe haemophilia A and a high inhibitor titre using recombinant f actor VIIa (rFVIIa) as the sole coagulation factor. There was no abnormal b leeding during surgery although an increased blood loss through surgical dr ains did occur during the first 6 h postoperatively. Rehabilitation was sta rted on day 1 and continued for 3 months. Walking commenced on day 4. After 1 year of follow-up, the clinical outcome of surgery was considered excell ent with no pain, knee mobility at 0-5-90 degrees, and an International Kne e Society score of 95/100. No rFVIIa-associated side-effects or thrombotic complications were reported. In conclusion, knee joint arthroplasty is now an option for haemophilia patients with a high inhibitor titre. An internat ional review of all available data on elective orthopaedic surgery in inhib itor patients is required so that the optimal treatment regime can be defin ed and the short- and long-term risk-benefit ratio of surgery compared to t hat of noninhibitor patients.