Pitfalls in Primary Total Knee Replacement

Abstract

Total knee replacement is a demanding surgical procedure, with high morbidity and cost. Often patients and their families as well as healthcare personnel experience a false perception of low risk, extrapolating from the rather uneventful operative and post-operative courses of primary total knee replacement in the non-hemophiliac patient. When performed in hemophilia treatment centers in the hands of experts, a total knee arthroplasty may yield moderate results, with infection rates of about 13% in HIV-negative patients and survival rates of about 77% at 10 years [1–3]. However, reproducing these results requires a sophisticated medical environment and an experienced hemophilia treatment group. An inexperienced surgeon may engage in this procedure, wrongly assuming that as long as the patient’s coagulopathy has been corrected, everything else will be the same as in a non-hemophiliac patient. This is not the case. Total knee arthroplasty in the hemophiliac requires additional planning, deviation from the standard surgical routine, and familiarity with a combination of technical difficulties seldom found in other conditions. My purpose in this chapter is to outline the technical difficulties that co-exist in total knee arthroplasty in hemophilia, so the reader may prepare for the surgical procedure.