Hemophilic arthropathy of the elbow treated by total elbow replacement. A case series.

Hemophilic arthropathy most commonly affects the knee, with the elbow being the second most frequently involved joint1. The recurrent intra-articular hemorrhages that cause this form of inflammatory arthropathy are a feature of severe hemophilia in which <1% of the normal clotting factor titers are present. Whereas total joint replacement is a well-documented treatment for hemophilic hip and knee arthropathy2-5, there are very few reports of total elbow replacements in patients with hemophilia. Possible reasons for this lack of published data include (1) the predominant and successful medical management of most patients with hemophilia, (2) less functional impairment of the elbow compared with the hip and knee in hemophilic arthropathy, and (3) the more recent successful evolution of total elbow arthroplasty compared with the more established hip and knee arthroplasties. Our aim is to share our experience with total elbow arthroplasty in patients with hemophilic arthropathy and to review the cases reported in the literature. We retrospectively reviewed the records on 3100 patients with hemophilia who had presented to our institution and on 1358 total elbow replacements performed at our institution between 1979 and 2001. Five patients had had total elbow replacement for the treatment of hemophilic arthropathy (Table I), and we further analyzed those cases. View this table: TABLE I Data on Five Patients with Hemophilia and a Total Elbow Arthroplasty The mean age of the five patients was thirty-nine years (range, twenty-five to fifty-eight years). The elbow on the dominant side was involved in one patient, the elbow on the nondominant side was involved in one patient, and both elbows were involved in three patients. The primary hematological abnormality was hemophilia A (factor-VIII deficiency) in two patients and hemophilia A and B (factor-VIII and IX deficiency), hemophilia C (von Willebrand disease), and hemophilia A with factor-VIII inhibitor in …