Background: Double total joint arthroplasty (TJA) can reduce repeat hospitalizations and total coagulation factors usage in hemophilic arthritis (HA) patients who have multiple joint involvement, but the risk of perioperative adverse events with double TJA must be considered.
Methods: We reviewed 50 patients who had hemophilia A, including 26 single TJA (STJA) (13 total knee arthroplasty [TKA] and 13 total hip arthroplasty [THA]) and 24 simultaneous double TJA (Sim-DTJA) (including 10 bilateral TKAs, 10 bilateral THAs, and four patients who had simultaneous THA and TKA). Length of hospitalization, blood loss, total exogenous coagulation factor VIII (FVIII) usage, perioperative FVIII levels, perioperative activated partial thromboplastin time (APTT), perioperative transfusion rates, and postoperative complications were assessed and compared.
Results: Perioperative FVIII levels and APTT were not different between Sim-DTJA and STJA. Total blood loss (1,216.0 ± 450.4 mL) and hidden blood loss (1,020.0 ± 419.9 mL) were slightly higher in Sim-DTJA than in STJA (1,062.0 ± 371.8 mL and 929.9 ± 351.6 mL, respectively) (P = 0.192, P = 0.416, respectively). The length of hospitalization between the Sim-DTJA (10.6 ± 1.8 days) and the STJA (10.4 ± 1.7 days) was not different (P = 0.802). The perioperative FVIII usage was 30,063 ± 6,466 IU for Sim-DTJA and 26,077 ± 12,524 IU for STJA (P = 0.008). No postoperative adverse events and prosthesis-related complications were reported in any of the patients. The two cohorts had no perioperative transfusion of erythrocyte and platelets.
Conclusion: In HA patients who had multiple joint involvement, Sim-DTJA can achieve clinical efficacy without significantly increasing perioperative blood loss, length of hospitalization, and postoperative complications.
Keywords: Hemophilic arthritis; bilateral TJA; blood loss; perioperative hematological management; simultaneous double TJA.
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