Orthopedic surgery in hemophilic patients with musculoskeletal disorders: A systematic review

Hemophilia is a hereditary coagulopathy caused by factor VIII (hemophilia type A) or by coagulation factor IX (hemophilia type B) dysfunction, characterized by an increased bleeding predisposition, which is either spontaneous or secondary to minimal trauma. Currently, hemophilia may also be considered an 'orthopedic' condition, due to the fact that it affects the musculoskeletal system of most hemophilic patients. In recent years, constant prophylaxis using coagulation factors has led to a significant improvement in the hemophilic patient's quality of life, by reducing both life-threatening hemorrhagic phenomena, as well as the occurrence of chronic complications. Nevertheless, progressive joint bleeding remains unavoidable in this category of patients, and the onset of chronic arthropathy with secondary motor deficiency remains the main complication with an invalidating character. In such cases, orthopedic management is imperative; osteoarticular complications being managed most often with the help of conservative or surgical techniques. The purpose of this review is to provide an overview of modern orthopedic practices which are useful in the management of hemophilic patients suffering from osteoarticular disorders.

Morphological characteristics and clinical significance of the distal femur in patients with hemophilia-related knee arthritis

This retrospective study aimed to define the morphological characteristics of the distal femur in patients with hemophilia-related knee arthritis (HA) and develop precise femoral component installation during total knee arthroplasty (TKA) using a reference axis.Computed tomography (CT) was performed in 75 patients [HA group: 34 patients, 48 knees; osteoarthritis (OA group): 41 patients, 48 knees] during 2017-2019. CT scans were constructed into three-dimensional models. We measured the medial (MPC) and lateral (LPC) posterior condyle widths, lateral anteroposterior (LAP) height, medial anteroposterior (MAP) height, mediolateral epicondyle (ML) width, and depths of the anterior patellar groove (X2) and the intercondylar notch (X4). Also, angles were measured between the posterior condylar line (PCL) and surgical transepicondylar axis (STEA) (PCA angle), anteroposterior axis (APA angle) and STEA (APSA angle), anterior condylar line (ACL) and STEA (ACA angle), and clinical transepicondylar axis (CTEA) and PCL (CTA angle). ML/MAP, ML/LAP, X4/LAP, X2/LAP, and LPC/ML ratios were calculated.There were no significant differences in any angles between the HA and OA groups (P > .05). However, the HA group had a smaller MPC (P < .05) and larger X4 than the OA group (P < .05). ML, ML/LAP, X2, MAP, and LAP showed no significant differences between the 2 groups.ML, ML/LAP, and PCA showed no significant differences between the 2 groups. During TKA in hemophilia-related knee arthritis patients, the femoral component can be installed with PCL as the reference axis, although individual differences should be considered.