TWENTY YEARS EXPERIENCE OF TOTAL KNEE ARTHROPLASTY IN END-STAGE HAEMOPHILLIC ARTHROPATHY OF THE KNEE

Abstract

Haemophilia care has steadily improved over the years and especially so during the last decade. The routine use of prophylactic treatment has undoubtedly resulted in a significant improvement in the life-style, quality of life and life expectancy of these patients, and bodes well for the future.

The knee is the most common joint affected in patients with severe haemophilia (approx 50%) and despite best efforts there is still a group of young adults who have a severe degree of knee joint destruction as a result of repeated articular bleeding episodes during their early years.

The indications for operation are primarily disabling pain that is unresponsive to medical treatment. Deformity and poor functional range of motion, particularly a severe flexion contracture of the knee, are relative indications and may in themselves justify joint replacement. Equally joint contractures and flexion deformity pose various surgical challenges for the surgeon. The introduction of continuous replacement clotting factor has facilitated the operation and in our experience has reduced the complications of TKR. We have found that it permits earlier rehabilitation and in our present series the outcome in this group of patients almost comparable to TKR performed in the general population.