Total knee replacement with and without emicizumab: a unique comparison of perioperative management

Emicizumab is a bispecific monoclonal antibody that mimics the activity of factor VIII (FVIII) and is approved for the prevention of bleeding in persons with severe FVIII deficiency with or without inhibitors.1,2 However, the reported experience with surgeries in persons on emicizumab is relatively limited to the published data from the Haven 1-4 trials, which include a total of 233 surgeries with 18 major surgeries in 18 patients and 215 minor surgeries among 115 patients.3 All 5 arthroplasties performed during these trials received a prophylactic factor with either FVIII concentrate or recombinant FVIIa (rFVIIa). More detailed and “real-world” experiences of arthroplasties in persons with FVIII deficiency and inhibitors while on emicizumab include an abstract by Santagostino et al4 who described a total hip arthroplasty in a 56-year-old man, a case report by Kizilocak et al5 of a 25-year-old man who had a total knee replacement, and a recent case report by Seaman and Ragni6 of the successful management of a man who underwent a total hip replacement.