PT03
‘Long-term survival of total hip and total knee arthroplasty in people with haemophilia’
G. Aertssen1,*, H. M. de Visser2,3, W. Foppen4, R. E. Schutgens1, M. A. Timmer1, L. F. van Vulpen1
1Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, 2Department of Orthopaedics, Division of Surgical Specialties, UMC Utrecht, 3Department of Orthopaedics, St. Antonius Hospital, 4Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, UMC Utrecht, Utrecht, Netherlands
Introduction: Total joint arthroplasty (TJA) offers pain relief and improved function in end-stage haemophilic arthropathy (HA). However, patients with haemophilia (PwH) face higher peri- and postoperative risks, including bleeding, infection, and lower prosthesis survival rates (PSR) compared to the general population. For total knee arthroplasty (TKA), the 15-year PSR in PwH is 84%; for total hip arthroplasty (THA), the 5-year PSR in PwH is 91,9%, while in the Dutch arthroplasty registry (LROI), TKA and THA have a 15-year PSR of respectively 92.8% and 93.7%
Aim To determine PSR and complication rate after TKA and THA and to identify predictors for failure in people with end-stage HA.
Methods: Regular care data of PwH or Von Willebrand’s disease treated at the Van Creveldkliniek (1989–2025) was extracted. Failure was defined as revision or loosening of prosthesis. PSR was estimated using Kaplan–Meier analyses. Predictors were assessed with Cox proportional hazards regression. Independent variables included: age, type of bleeding disorder, treatment regimen, HIV status, hepatitis C status, concomitant surgery, overall joint status, pre/post-operative hemoglobin difference, length of hospital stay, loading protocol, inhibitor status, early post-operative bleeding, pre-operative angiography and post-operative infection.
Results: In total 139 TKA and 71 THA were included, containing 11 TKA revisions and 7 THA revisions. The 15-year PSR for primary TKA in PwH was 92.2% (number at Risk (nR)=71, 95% CI [87.5-97.3]) and the 25-year PSR 90.9% (nR=28, 95% CI [85.5-96.6]). The 15-year PSR for primary THA in PwH was 91.1% (nR=27, 95% CI [82.8-100]) and 25-year PSR 79% (nR=14, 95% CI [64.8-95.5]). In TKA, patients with an inhibitor at time of surgery had 32.3 times higher risk for failure (p<0.001) and those with a post-operative infection at any moment during follow-up had a 15.7 times higher risk (p<0.001). In THA, each additional year of age at time of surgery increased the risk of failure by 1.08 (p=0.031). Complication rate (TKA 40%, THA 28%) consisted mainly of bleeding (THA 32%, THA 18%).
Discussion/Conclusion: In our Dutch sample, the prothesis survival rate for patients with end-stage HA was comparable to that of the general population, despite relatively high complication rates. A peri-operative inhibitor and post-operative infection (TKA) and a higher age (THA) were negative predictors for survival.
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Disclosure of Interest: None declared