In the era of primary prophylaxis in hemophilia, what types of orthopedic surgical interventions have been published in the 2020–2023 period and in which countries?

ABSTRACT

Introduction

Primary prophylaxis has significantly reduced the number of orthopedic surgical procedures performed on patients with hemophilia (PWH) worldwide. However, studies on orthopedic surgery in PWH are still being published in the medical literature.

Areas covered

The aim of this article is to determine the types of orthopedic surgical interventions in PWH published between 2020 and 2023 and the countries in which they are published.

Expert opinion

The following orthopedic surgical procedures are still performed on PWH: total knee, ankle, elbow and hip arthroplasty, ankle fusion, ankle distraction, and the surgical removal of hemophilic pseudotumors. The countries in which articles on orthopedic surgery in hemophilia have been published in the period 2000–2023 include China (14 articles); Republic of Korea and U.S.A. (3 articles each); Germany, Italy, Japan, Poland and Turkey (2 articles each); and 1 article each in the following countries: Austria, Belgium, Chile, France, Ireland, New Zealand, Russia, and The Netherlands. These data suggest that primary prophylaxis should be improved and extended to all patients globally.

KEYWORDS:

• Hemophilia
• orthopedic surgery
• perioperative hemostasis
• results
• complications

Article highlights

• Despite the use of primary hematologic prophylaxis, orthopedic surgery continues to be performed in many parts of the developed world, suggesting that primary prophylaxis is not yet fully effective or that it is not being used adequately.

• The prevalence of early (within 30 days) wound complication in PWH without preoperative infection is 6.5%.

• The overall complication rate after TKA in hemophilic knee arthropathy is approximately 22%.

• Primary and revision TKA/THA in PWH with inhibitors might be currently deemed safe and efficacious if performed in dedicated multidisciplinary centers.

• Surgical resection for hemophilic pseudotumors appears to be a safe and efficacious technique.

• Multiple joint procedures under one type of anesthesia are more cost-effective for PWH, with less factor consumption than staged single joint procedure.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.