Total joint replacement in inhibitor-positive haemophilia:Long-term outcome analysis in fifteen patients  

作　　者：Heidi Danielson Riitta Lassila Pekka Ylinen Timo Yrj?nen 

机构地区：[1]Orton Ortho-paedic Hospital,Invalid Foundation [2]Helsinki University and Coagulation Disorders unit,Department of Haematology and Comprehensive Cancer Centre,Helsinki University Hospital

出　　处：《World Journal of Orthopedics》2017年第10期777-784,共8页世界骨科杂志（英文版）

摘　　要：AIM To collect data from joint replacement in inhibitor patients, evaluate haemostatic and patient outcomes, and analyse the costs.METHODS We report our 21-year, single-centre cumulative experience of 15 joint arthroplasties in six inhibitor patients.RESULTS Two low responder inhibitor patients were in the early days treated with FVIII, whereas bypassing agents were used in the rest of the high responder patients. The primary haemostatic outcome was good in 8/15, fair in 4/15 and poor in 3/15 operations. The overall patient outcome, including joint health and patient satisfaction, was good in 10/15, fair 4/15 and poor in 1/15. No deep infections were observed. Cost analysis was most beneficial in low responders and in two immune-tolerized, high responder patients. In all cases, factor replacement comprised the main treatment costs.CONCLUSION Our experience supports the initial use of bypassing agents as well as preoperative immune-tolerance induction when possible. Despite the challenges of haemostasis and severe joint disease, total joint arthroplasty can reach a good outcome, even in inhibitor patients. The risk for deep infection might be smaller than previously reported. Individual planning, intense multidisciplinary teamworkand execution of operations should be centralised in a professional unit.AIM To collect data from joint replacement in inhibitor patients, evaluate haemostatic and patient outcomes, and analyse the costs.METHODS We report our 21-year, single-centre cumulative experience of 15 joint arthroplasties in six inhibitor patients.RESULTS Two low responder inhibitor patients were in the early days treated with FVIII, whereas bypassing agents were used in the rest of the high responder patients. The primary haemostatic outcome was good in 8/15, fair in 4/15 and poor in 3/15 operations. The overall patient outcome, including joint health and patient satisfaction, was good in 10/15, fair 4/15 and poor in 1/15. No deep infections were observed. Cost analysis was most beneficial in low responders and in two immune-tolerized, high responder patients. In all cases, factor replacement comprised the main treatment costs.CONCLUSION Our experience supports the initial use of bypassing agents as well as preoperative immune-tolerance induction when possible. Despite the challenges of haemostasis and severe joint disease, total joint arthroplasty can reach a good outcome, even in inhibitor patients. The risk for deep infection might be smaller than previously reported. Individual planning, intense multidisciplinary teamworkand execution of operations should be centralised in a professional unit.

关 键 词：HAEMOPHILIA Joint REPLACEMENT INHIBITOR Cost analysis ARTHROPLASTY 

分 类 号：R687.4[医药卫生—骨科学]