Arthoplasty in persons with haemophilia in Indian scenario
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:93
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Nandan D, Dash K K, Rao N
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Introduction: Hemophilic arthropathy leads to severe pain, deformity and functional disability. Moreover, in India, late presentation and lack of awareness leads to further complications. Total Joint Arthroplasty has been shown to be effective in reducing both pain and tendency to bleed into the joint, leading consequently to dramatically improved function.
Materials and Methods: This study involved all arthroplasties in hemophilics in our tertiary care centre between June 2009 to May 2012 (No. of joints = 11, No. of Patients = 6, Average follow-up period 380 days). Preop medical records were reviewed and radiological scoring for hemophilic arthropathy and bone loss was done. Pre-validated widely used joint scores (KSS, HSS, Harris Hip Score) were used both pre and postoperatively. Patient satisfaction and complications of the surgery were also evaluated.
Results: The study included 6 Total Knee Arthroplasties (TKA), 4 Total Hip Arthroplasties (THA) and one Bipolar Hemiarthroplasty. Average age of PWHs was 41.6±5.97 years. Pre-op radiological score (Petterson) ranged from 11 to 13 (Avg. 11.5). Four cases of TKA had severe bone loss at presentation (two Type 3 AORI and two Type 1 AORI). All patients were satisfied with pain relief and functional improvement. Avg. Oxford Hip Score increased from 18.8 to 41.8 and Avg. Harris Hip Score from 33.76 to 89.88. Cases of TKA showed similar results in Oxford Knee Score (14.83 to 44.16), HSS Knee Score (17 to 88.33), Knee Society Score(12 to 70.16) and Knee Society Function Score(20.83 to 78.33). Comorbidities such as HIV (n=1), HCV (n=3), TB (n=1) were present but no incidence of mortality, superficial/deep infection, implant loosening, hemarthrosis etc were found. Three cases showed delayed wound healing and soakage at wound site, 2 of which requires secondary suturing. One case developed pressure sore due to brace which healed uneventfully. Three TKAs with bone loss requires stem extenders (augments in one case). Average expenditure for factor replacement was 1.57 lakh INR.
Conclusion: We conclude that arthroplasty in PWH, although technically challenging, can be done with very good results and without any serious complication by a team based approach, involving haematologists, orthopaedic surgeons, physiotherapists, occupational therapists, immuno-hematological facilities and good lab support.
|How to Cite this Abstract|
|Nandan D, Dash K K, Rao N. Arthoplasty in persons with haemophilia in Indian scenario. International Journal of Conference Proceedings 2015;(2015):93|