Abstract
Purpose
This study was performed to evaluate clinical and radiographic outcomes of Hip Resurfacing Arthroplasty for treatment of haemophilic hip arthropathy.
Material & Method
Between 2002 and 2013, 17 cases of hip resurfacing arthroplasties were performed in 16 haemophilic patients (13 cases of haemophilia A, 2 cases of haemophilia B, 2 cases of von Willebrand disease). The average age of the patients was 32.5(range: 18∼52) years. The average follow up period from the operation was 6.3 (range: 2∼13) years. In this study, the subjects that completed follow-up were composed of 5 cases composed of patients who were treated with Conserve plus® hip resurfacing system, 5 cases composed of patients who were treated with Durom® hip resurfacing system, 4 cases who were treated with ASR® hip resurfacing system, and 3 cases who were treated with Birmingham® hip resurfacing system. The Modified Harris hip score, the range of motion of the hip joint, perioperative coagulation factor requirements and complications associated with bleeding were evaluated as part of the clinical assessment. For the radiographic assessment, fixation of component, presence of femoral neck fracture, osteolysis, loosening and other complications were evaluated.
Results
The modified Harris hip score improved from 65.4(47–80) points before surgery to 97.8(90–100) points at the last follow-up. The average further flexion improved from 103° (70–135) to 110°(80–130) after surgery. The average abduction improved from 22.4° (0–45) to 41.3° (20–50) after surgery. All the patients showed a significant reduction in pain. The mean requirement of factor VIII reduced from 2470 units per month before surgery to 1125 units per month at the time of the last follow-up. However, in the case of high-titer inhibitor to factor VIII, haemophilia B, von Willebrand disease, the average monthly factor requirement was not changed due to bleeding episode of other joints. There was two cases of re-bleeding. There were no femoral neck fracture, no osteolysis, and no implant loosening in last follow up.
Conclusion
Hip resurfacing arthroplasty for haemophilic hip arthropathy in patients with mild deformity or relatively preserved range of the hip joint motion can bring reliable pain relief, functional improvement, and reduction of factor requirement for over two years follow-up study. However, bleeding-associated complications are a cause for concern, especially for patients with antibodies against coagulation factors.
