Surgical treatment in heamophilic patients with musculoskeletal disorder

Objective To study the surgical treatment strategy for heamophilic arthropathy and musculoskeletal apparatus. Methods A total of 120 heamophilic patients underwent 166 primary operations from January 1996 to June 2015 in Peking Union Medical College Hospital, with the average age of 29.7±12 years (from 6 to 61 years). Hemophilic type A accounted for 109 patients and hemophilic type B accounted for 11. Eighty-seven patients presented with bleeds within the joints, with 63 cases for knee involved, 29 cases for hip, 11 cases for ankle. Fifteen patients presented with intramuscular bleeds, 21 patients with heamophilic pseudotumors. Strategy of clotting factor replacement therapy was designed according to the different level of operation procedure. The clinical manifestation, operative strategy, clinical outcome and complications were retrospectively recorded. Results 41 cases (34.2%) of patients underwent surgeries for more than one location. Totally, 166 procedures were performed for 120 patients. There were 103 procedures of joint arthroplasty (62.0%, 103/166), 21 procedures of pseudotumor resection (12.7%, 21/166), 15 procedures of tendon lengthening, 12 procedures of ankle arthrodesis, 13 procedures for knee flexion contracture. There were 30 cases of postoperative complications, with the rate of 18.1% (30/166). The coagulation related complication was 4.8% in this group (8/166). The surgical procedure related complication was 7.2% (12/166). All the preoperative symptoms were relieved during the follow-up. Conclusion Surgical treatment was effective for the heamophilic arthropathy and lesion of musculoskeletal apparatus, under the reasonable clotting factor replacement therapy. The incidence of perioperative complication in heamophilic patients is higher than that in non-hemophilic patients. Closely inspection was inevitable for perioperative treatment in hemophilic patients. Key words: Hemophilia; Osteoarthritis; Arthroplasty, replacement; Arthrodesis