Total Knee Arthroplasty in Hemophilia: Survivorship and Outcomes-A Systematic Review and Meta-Analysis.

Abstract Background Patients with hemophilia (PWH) may experience spontaneous or traumatic bleeding episodes. Recurrent bleeding can lead to end stage hemophilic arthropathy and total knee replacement (TKR) provides an effective treatment. The aim of this study is to investigate outcomes in PWH who undergo TKR. Methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study outcomes included patient reported functional outcomes, implant survivorship and complications. Subgroup analysis was performed assessing the effect of recombinant prophylaxis medication by comparing studies that included only TKRs performed after the year 2000 (period A), to those that included TKRs before 2000 (period B). Results Twenty-eight studies were included, with a total of 1,210 TKRs performed in 917 PWH. The mean age of patients was 38.5 years (SD 5.1) with a mean length of follow up of 7.1 years (SD 2.9). The total complication rate was 28.7%, with 19.3% requiring a further procedure. HSSKS improved by 44.6 points (CI 38.9-50.4) and KSS function improved by 35.9 points (CI 30.1-41.8). Total ROM improved by 22.3 degrees. The most common complication was post-operative haemarthrosis (7.6%, 92 TKRs). Deep infection (6.2% vs. 3.9%) and aseptic loosening (3.8% vs. 2.1%) rates fell between period B and period A. Conclusions TKR in PWH is a successful procedure improving function, reducing pain, and improving ROM. PWH undergo TKR at a younger age and have a higher risk of complications, though contemporary treatment has reduced these risks. PWH can expect similar survivorship to the general population.