Perioperative management of hemophilia patients receiving total hip and knee arthroplasty: a complication report of two cases

Abstract

Toshiyuki Tateiwa,1 Yasuhito Takahashi,1,2 Tsunehito Ishida,1 Kosuke Kubo,1 Toshinori Masaoka,1 Takaaki Shishido,1 Keiji Sano,1 Kengo Yamamoto11Department of Orthopedic Surgery, 2Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, JapanAbstract: It has been recognized that perioperative hemostasis management after joint-replacement surgery for hemophilia patients is complicated and cumbersome, due to the necessity of rigorous monitoring for clotting-factor levels throughout the infusion. Between 2005 and 2014, we examined seven patients with hemophilia A (ten joints: six hips and four knees) receiving total hip or knee arthroplasty (THA or TKA) for hemophilic arthropathy. One male patient (31 years old) showed an intra-articular hematoma formation after THA (case 1). In another male patient (46 years old) receiving TKA, the postoperative trough factor VIII level became lower significantly than reference levels (80%–100% for the 5–10 postoperative days) recommended by the guidelines from the Japanese Society on Thrombosis and Hemostasis, despite sufficient coagulant based on the guidelines being administered (case 2). In the latter patient, deep infection and hematoma formation were observed postoperatively. In this article, we provide a detailed clinical report regarding these two complication cases at the early postoperative periods, and the management of bleeding control for hemophilia patients is discussed.Keywords: hemophilia A, arthroplasty, clotting factor VIII levels, hematoma, infection