Total knee replacement for patients with severe hemophilic arthropathy in Taiwan: A nationwide population-based retrospective study.

BACKGROUND Total knee replacement (TKR) surgery is a treatment option for advanced hemophilic arthropathy. Due to its rarity and complexity, previous reports could only demonstrate the results of single-site studies including few cases. This population-based study aimed to investigate the major epidemiological characteristics, mean consumption of coagulation factors, length of hospital stays, complications, and failure rate of primary TKR for severe hemophilia patients in Taiwan. METHODS A cohort of 996 hemophilia patients registered between 1995 and 2011 were included, and 103 primary TKRs were performed on 75 patients. Unilateral TKR was performed on 47 patients and bilateral TKRs on the remaining 28 patients, including 12 simultaneous and 16 staged surgeries. The mean age at surgery was 32.3 years (range: 17.3-55.7), and the mean follow-up duration was 77.9 months (range: 2.3-176.8). RESULTS Failure was noted in 8 patients (8.5%) at mean 32.8 months (range: 2.3-95) after surgery. Four patients revealed aseptic loosening, whereas infection in 4. The 10-year prosthesis survivorship was 88.6%. For patients receiving unilateral TKR, the mean length of hospital stay was 15 days (range: 7-32). The mean cost of factor supplement was USD 43,543 with a mean 4-unit packed RBC transfusion (range: 0-38). The total admission cost was USD 48,326 (range: USD 4,165-262,619). CONCLUSION The prevalence of TKA for hemophilia patients was 7.5% in Taiwan. The mean hospital stays was 14 days and the 10-year prosthesis survivorship was 88.6%. The mean daily factors usage was decreased from 235.7 unites preoperatively to 202.1 units postoperatively. In comparison with the staged-bilateral TKRs, the simultaneous procedures significantly reduced the mean total cost from USD 101,923 to USD 61,587 (p=0.023). Therefore, in terms of cost-effectiveness, bilateral simultaneous TKR is more preferable than staged procedures.

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