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Expert Review of Hematology Volume 9, 2016 - Issue 1

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Review

Patient dissatisfaction after total knee arthroplasty for hemophilic arthropathy and osteoarthritis (non-hemophilia patients)

E. Carlos Rodriguez-MerchanDepartment of Orthopaedic Surgery, La Paz University Hospital, Madrid, SpainCorrespondence[email protected]

Pages 59-68 | Published online: 11 Nov 2015

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https://doi.org/10.1586/17474086.2016.1112263
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• The authors stated that between the second and fourth decades, many hemophilic patients develop joint destruction (arthropathy). At this stage, possible treatments include alignment osteotomy, arthroscopic joint debridement, arthrodesis (joint fusion) and total joint arthroplasty. Muscular problems must not be underestimated in hemophilia due to their risk of developing compartment syndromes and pseudotumors.

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• The authors stated that improving patient outcomes by increasing the use of FVIII prophylaxis, preventing or eliminating FVIII inhibitors and expanding access to FVIII concentrates in developing countries are the major challenges confronting clinicians who care for patients with hemophilia A.

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• The author asks why are recombinant products not used more extensively given their high efficacy and maximum safety? He states that we are faced with an interesting but also unfortunate paradox of pharmacology that greater progress in therapeutic procedures is not always associated with greater introduction of those resources that are safest, for the simple reason that they are more costly.

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• In a 38-year period, 500 radiosynovectomies (RS) were performed in patients with hemophilia diagnosed with chronic synovitis. The RS was carried out with either yttrium-90 or rhenium-186. The authors performed 1–3 injections (RS-1, RS-2, RS-3), with a 6-month interval between them. On average, the number of hemarthroses decreased by 64.1%. The rate of complications was 0.9 and 6.3% joints eventually had to be subjected to arthroscopic synovectomy or total knee replacement. RS proved to be an effective, safe, minimally invasive, well-tolerated procedure in the long term for the treatment of chronic hemophilic synovitis. Moreover, it is very easy to perform.

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Patient dissatisfaction after total knee arthroplasty for hemophilic arthropathy and osteoarthritis (non-hemophilia patients)

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• The authors stated that improving patient outcomes by increasing the use of FVIII prophylaxis, preventing or eliminating FVIII inhibitors and expanding access to FVIII concentrates in developing countries are the major challenges confronting clinicians who care for patients with hemophilia A.

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Patient dissatisfaction after total knee arthroplasty for hemophilic arthropathy and osteoarthritis (non-hemophilia patients)

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• The authors stated that improving patient outcomes by increasing the use of FVIII prophylaxis, preventing or eliminating FVIII inhibitors and expanding access to FVIII concentrates in developing countries are the major challenges confronting clinicians who care for patients with hemophilia A.

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