Outcome of total knee arthroplasty combined patelloplasty for end-stage type A hemophilic arthropathy

The aim of this study was to retrospectively evaluate the outcome of total knee arthroplasty for end-stage hemophilic arthropathy, based on effectiveness of operation, the specificity of surgical technique, the complications of TKA operation and the strategy of handling of patella. Nineteen patients (25 knees) with type A hemophilic arthropathy were treated with TKA from June 2003 to February 2010. Average patella thickness was 16.3 ± 0.4 mm and all patellas were treated by patelloplasty. The patient followed up data was recorded, which included the information of hospital for special surgery knee score(HSS), range of motion(ROM), post-operative complication, and anterior knee pain. The patients were followed for an average post-operative period of 41 months (10 to 78 months). The mean preoperative HSS score was 51 (31 to 64). Post-operative HSS score was 91 (75 to 110) when followed-up. ROM was modified to 82 degree (60 to 105), compared with 55 degree (5 to 110) preoperatively. Thirteen patients with flexion contracture were corrected from 19 degree (0 to 45) to 2.7 degree (0 to 10). Four patients complained mild but endurable anterior knee pain. The study concludes that TKA is an effective treatment for end-stage hemophilic arthropathy of knee joint, providing good clinical outcome and improving quality of life. Patella of hemophiliac is relatively thin and osteoporotic. Patelloplasty is useful technique for handling of patella during TKA procedure for hemophiliac, with improved knee function, low and acceptable anterior knee pain rate, low reoperation rate.