Improving the Success Rate of Total Joint Replacement

Improving the Success Rate of Total Joint Replacement

Bleeding into the joints occurs very commonly in people with hemophilia. Most commonly, the ankles, knees, and elbows are affected. With time, this bleeding destroys joint tissues to the point that a total joint replacement may be necessary.

One research team followed individuals born with bleeding disorders for success of total joint replacement and the safety and effectiveness of standard therapies given to prevent bleeding. The investigators analyzed data on 28 persons, including 21 with hemophilia and 4 with hemophilia B. In all, the group underwent a total of 29 total knee replacements and 9 total hip replacements.

Among 27 individuals who underwent total knee replacement, seven had better range of motion of the replaced joint after two months. At 1½ years after total knee replacement, 17 of 29 individuals had better range of motion, and all had less knee pain. All of the nine people who had total hip replacement had better range of motion.

All 25 people who had a total knee replacement had significant pain improvement; 24 had better joint function, and all 25 said they would choose to have the surgery if they had another chance to make the choice. Likewise, all six individuals who had total hip replacement had improved joint pain and function, and five said they would choose to undergo the surgery again.

To prevent blood clotting, a drug known as low-molecular-weight heparin was given for 29 of the 38 operations. However, therapy was stopped in three persons for bleeding not related to the joints or possible blood loss. None of the participants had any blood clots. Five people who had total joint replacement developed a skin infection, and two who didn't use that kind of heparin had bleeding into the joint spaces. Later, complications of the surgeries including a loosening of the knee replacement that required another surgery, a case of an infected joint, and a shortening of muscle and tendons that caused unnatural bending of the joint.

What Does This Mean for People With Hemophilia?

This study provides us with a glimpse of how total joint replacement can improve the quality of life for people with hemophilia. Prevention of blood clots is a tricky business when hemophilia is involved; use of low-molecular- weight heparin decreases the risk of this complication. In these individuals, few problems were reported after surgery. Overall, these persons with hemophilia were satisfied with their decision to undergo total joint replacement surgery and enjoyed improvement in pain relief and function.

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