Purpose: Total knee arthroplasty (TKA) is safe and effective in patients with advanced hemophilic arthropathy. This procedure is extremely successful in pain relief and improving functional status, however the limited restoration in motion due to preexisting soft tissue contractures, remains a concern. The purpose of this study is to report the results of TKA in patients with hemophilia using posterior cruciate ligament (PCL) sacrificing prostheses.

Materials and Methods: The records of 18 consequtive hemophilic arthropathy patients who underwent total knee arthroplasty at our institution between 1998 and 2003 were retrospectively reviewed. The patients were evaluated by International Knee Society (IKS) Scoring system with specific attention to range of motion parameters and functional status at preoperative and postoperative clinical evaluation. Postoperative radiologic evaluation was based on the knee Society roent-genographic evaluation and scoring system.

Results: The average age at operation was 34 years (range, 18–60) with an average follow-up of 51 months (range, 12–74). TKA resulted in an improvement in functional and knee scores, and range of motion parameters (p< 0,01). However, the functional status of the patients improved better than the knee status (p < 0,01). No signs of radiographic loosening were seen in any of the components at the final follow-up evaluation. There were two early hemarthrosis which required open lavage. Four patients had late complications. One patient had a periprosthetic fracture, which was treated with open reduction and internal fixation. Another patient had tibial tubercle avulsion and conservative treatment was choosen. One patient had revision secondary to progression of flexion contracture due to repetitive intraarticular hemorrhage, at the third year (26th month). One patient had deep infection.

Conclusions: Our results demonstrate the excellent results in terms of functional scores and to a lesser extent in knee scores. Evaluation of the subcategories of the knee score demonstrated the limited restoration of motion as the reason for lower success rate in knee scores. Although PCL sacrificing designs allow better motion restoration, futher techniques should be developed to release the extraarticular structures that contribute to the flexion contracture, such as hamstring release.