THE ORTHOPAEDIC MANAGEMENT OF HAEMOPHILIA IN NEW ZEALAND

Abstract

The aim of this study is to identify specific risk factors for developing haemophilia related orthopaedic complications and to provide a qualitative and quantitative analysis of the orthopaedic management of haemophilia complications.

A postal survey was sent to 48 patients on the Wellington region haemophilia database. The questionnaire covered both qualitative and quantitative questions covering the participants’ current condition and treatment, past and present orthopaedic and non-orthopaedic management, support, education, employment and leisure activities.

Twenty-five patients returned the questionnaire, a response rate of 52%, Most of the participants (68%; 17/25) felt that their education had been compromised as a result of haemophilia complications. Of those participants that were 16 years or older, 68.4% (13/19) felt that their working opportunities had been compromised as a result of haemophilia complications. Despite patients less than 18 years of age receiving prophylactic Factor VIII replacement (n=7) and all patients having Factor VIII available on demand, 18 patients had significant bleeds in the previous 6 months. Most bleeds were into joints, 13 knees, 13 ankles, 12 elbows, 6 shoulders and 3 hips, but a significant number of intra-muscular bleeds (n=22) also occurred. There were 62 painful joints reported by 19 patients, the ankle being most common (n=21), followed by hip (n=13), elbow (n=12), and knee (n=8). Twenty orthopaedic operations were described by 8 patients, mainly knee (n=6) and hip (n=3) replacements, and synovectomies (n=6). Discussion.

Despite good medical management, recurrent joint bleeds are a major problem in haemophilia. Many study patients commented that orthopaedic procedures were not performed readily enough, and that by the time they received their operation, their function had deteriorated significantly.