Hemofili A Hastalarındaki Diz Artropatisi ve Bilateral Total Diz Artroplastisi Oranı

Abstract

Amaç:

 

Hemofili hastalarında epidemiyolojik olarak yapılan çalışmamızda, bir üniversite hastanesinin hematoloji-ortopedi ortak kayıtları kullanıldı. Bu çalışmanın amacı, diz problemleri olan orta ve ağır hemofili hastalarından elde edilen bilgileri, hastaların yaşı ve radyolojik açısından degerlendirmekti. 

 

Gereç ve Yöntemler:

 

Retrospektif bir çalışma olup, iskelet-kas sistemi problemleri olan 130 hemofili A hastasından diz problemli 49’u bu çalısmaya dahil edildi. Kellgren-Lawrence(KL) sınıflaması, osteoartritlerin radyolojik degerlendirmesinde kullanıldı.  Elektronik datalardan elden edilen bilgiler, sonuçları analiz etmek ve istatistiksel degerlendirmeler icin kullanıldı.   

 

Bulgular:

 

Düz diz grafiği çekilmiş hastaların çoğunluğunda (27/39, %69,23), KL derecesi 3 veya 4 idi. KL derecesi ile hastaların yaşları arasında istatistiksel olarak anlamlı bir korelasyon mevcut idi (Spearman’s : r_s = 0,512, p (2-tailed) = 0,001). Ayrıca, KL derecesi 4 olan 50 yas ve altında 7 hasta (%14,29) vardı. 

 

49 diz problemi olan hastanın 25’inde (%51.02) total diz artroplasti (TDA) yapıldı ve bunların da 10 tanesi (%40) bilateral idi. Bilateral TDA icin ortalama yas (56.35), unilateral TDA dan (49.87) daha yüksekdi.

 

Hastaların yaşı ile TDA olmaları arasında istatistiksel olarak anlamlı bir korelasyon vardi (Spearman’s: r_s = 0,338, p = 0,017).  35 TDA yapılan hastada 2 revizyon tesbit edildi (%5.71). çalışmaya dahil edilen hastaların çogu (43/49, %87.75), profilaktik faktör tedavisi almaktaydı

 

 Sonuç:

 

Çalışmamız, hemofili A hastalarındaki yüksek bilateral TDA oranını ve normal popülasyona gore bu grubunun ne kadar erken yasta KL 4 safhasına ilerlediklerini vurgulamaktadır. Bu sonuclar bize, bu grup hastalardaki tedavi yaklaşımının, yakin takibin ve profilaksinin önemini göstermektedir. Bu hastalardaki risk ve komplikasyonları azaltmak icin, tedavileri, tecrübeli merkezlerde ve özelleşmiş bir grup tarafından yapılmalıdır.    

Keywords

• Hemofili A,Total Diz Artroplastisi,Bilateral

Knee Arthropathy and Bilateral Total Knee Arthroplasty Ratio in Hemophilia A Patients

Abstract

Objective:

This epidemiological study was conducted in the joint haematology-orthopaedics clinic of a university hospital. The aim was to analyse the data in terms of age and radiology of patients with moderate or severe haemophilia A and knee involvement.

 

Materials and Method:

This was a retrospective study 49 patients with knee problems out of 130 haemophilia A and musculoskeletal problems. Kellgren-Lawrence (KL) classification was used for radiological assessments of osteoarthritis degree.

 

Results:

KL degree was 3 or 4 for most patients (27/39, 69.23%) in the group. There was statistically a meaningful correlation between KL degree and patients’ age (Spearman’s: r_s = 0.512, p = 0.001). There were 7 patients with KL degree 4 at the age of 50 or younger (14.29%).

 

25 patients in 49(51.02%) had total knee arthroplasty(TKA) and 10(40%) of those was bilateral.  Mean age for bilateral TKA(56.35) was higher than unilateral(49.87).

 

There was a statistically meaningful correlation between patient age and the patients with TKA (Spearman’s: r_s = 0.338, p = 0.017). There were 2 revision surgeries out of 35 TKA (5.71%). Most of the patients had prophylactic factor treatment (43, 87.75%).

 

Conclusion:

Our study signify the high ratio of bilateral knee replacements in haemophilia A patients and how early age they progressed to KL stage 4 comparing to normal population. These results show the importance of patient care in this group of patients, close follow-up and prophylactic treatment. They should be managed in experienced centres by an experience team to decrease the risks and complications.

Keywords

• HemophiliaA,Total knee arthroplasty,Bilateral

References

1. 1- Rizzo AR, Zago M, Carulli C, Innocenti M. Orthopaedic procedures in haemophilia. Clinical Cases in Mineral and Bone Metabolism. 2017;14(2):197-199.
2. 2- White B, Lee CA. Chapter 1: The diagnosis and management of inherited bleeding desorders. In: Rodriguez-Merchan EC, Goddard NJ, Lee CA, editors. Muscoloskeletal Aspects of Haemophilia. Cambridge: Blackwell Science Ltd; 2000. p.3–8.
3. 3- Fijnvandraat K, Cnossen MH, Leebeek FW, Peters M. Diagnosis and management of haemophilia. BMJ. 2012; 344:e2707.
4. 4- Liddle A, Rodriguez-Merchan EC. Evidence-Based Management of the Knee in Hemophilia. JBJS Reviews. 2017; 5(8); e12.
5. 5- White GC, 2nd, Rosendaal F, Aledort LM, Lusher JM, Rothschild C, Ingerslev J. Factor V, Factor IXS. Definitions in hemophilia. Recommendation of the scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the International Society on Thrombosis and Haemostasis. Thromb Haemost. 200;85-3:560.
6. 6- Manco-Johnson MJ, Abshire TC, Shapiro AD, Riske B, Hacker M R, Kilcoyne R, et al. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe haemophilia. N Engl J Med. 2007;357:535–544.
7. 7- Petterson H. Modern Radiologic Evaluation and Follow-up of Hemophilic Arthropathy. New York: The National Hemophilia Foundation;1986 8- Rodriguez-Merchan CE, Valentino LA. Orthopedic disorders of the knee in hemophilia: A current concept review. World J Orthop. 2016;18;7(6): 370-375.
8. 9- Napolitano M, Kessler CM. Chapter 3 Hemorrhagic Processess. Hemophilia A and B. In Consultative hemostasis and thrombosis. 4th edition. Kitchens C S, Kessler C M, Konkle B A. 4th edition. Elsevier Saunders, Philadelphia, USA, 2019. p.39-58.

9. 10- Carulli C, Villano M, Bucciarelli G, Martini C, Innocenti M. Painful knee arthroplasty: definition and overview. Clin Cases Miner Bone Metal. 2011;8:23–25.
10. 11- Vanderhave KL, Caird MS, Hake M, Hensinger RN, Urquhart AG, Silva S, Farley FA. Review article: Musculoskeletal Care of the Hemophiliac Patient. J Am Acad Orthop Surg. 2012;20: 553-563.
11. 12- Carulli C, Matassi F, Civinini R, Morfini M, Tani M, Innocenti M. Intra-articular injections of hyaluronic acid induce positive clinical effects in knees of patients affected by haemophilic arthropathy. Knee. 2013;20(1):36–39.
12. 13- Solimeno LP, Pasta G. Knee and Ankle Arthroplasty in Hemophilia. J Clin Med. 2017;6(11):107.
13. 14- Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.
14. 15- Social Science Statistics. https://www.socscistatistics.com/Default.aspx access date 15.03.2019
15. 16- Ozdemir E, Caglar O. Review; Primer total diz artroplastisinde hastalığa özgü komplikasyonlar Disease specific complications in primary total knee arthroplasty. TOTBİD Dergisi. 2019;18:237–241.
16. 17- Kruse-Jarres R, Pajewski NM, Leissinger CA. The Role of Race and Ethnicity in the Clinical Outcomes of Severe Hemophilia A Patients with Inhibitors. Blood. 2007;110:1163.
17. 18- Rodriguez-Merchan EC. What´s New in Orthopedic Surgery for People with Hemophilia. Arch Bone Jt Surg. 2018; 6(3):157-160.
18. 19- Tagariello G, Iorio A, Santagostino E, Morfini M, Bisson R, Innocenti M, et al. Comparison of the rates of joint arthroplasty in patients with severe factor VIII and IX deficiency: an index of different clinical severity of the 2 coagulation disorders. Blood. 2009; 114(4):779-784.
19. 20- Jiang C, Zhao Y, Feng B, Zhai J, Bian Y, Qiu G et al. Simultaneous bilateral total knee arthroplasty in patients with end-stage hemophilic arthropathy: a mean follow-up of 6 years. Sci Rep. 2018;8(1):1608.
20. 21- Kurtz S M, Ong K L, Lau E, Widmer M, Maravic M, Gomez-Barrena E, et al. International survey of primary and revision total knee replacement. Int Orthop. 2011;35(12):1783–1789.
21. 22- Lyons M C, MacDonald S J, Somerville L E, Naudie DD, McCalden RW. Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res. 2012;470: 84-90.
22. 23- Goddard NJ, Mann HA, and Lee CA. Total knee replacement in patient with end-stage haemophilic arthropathy. JBJS British volume. 2010;92-B:8,1085-1089.
23. 24- Kohn MD, Sassoon AA, Fernando ND. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res. 2016;474(8):1886-93.
24. 25- Guermazi A, Hayashi D, Roemer F, Felson DT, Wang K, Lynch J, et al. Severe radiographic knee osteoarthritis--does Kellgren and Lawrence grade 4 represent end stage disease?--the MOST study. Osteoarthritis Cartilage. 2015;23(9):1499-505.
25. 26- Lethbridge-Cejku M, Scott WW, Reichle R, Ettinger WH, Zonderman A, Costa P, et al. Association of Radiographic Features of Osteoarthritis of the Knee with Knee Pain: Data from the Baltimore Longitudinal Study of Aging. Arthritis Care and Research . 1995; 8( 3): 182-188.
26. 27- Thès A, Molina V, Lambert T. Simultaneous bilateral total knee arthroplasty in severe hemophilia: A retrospective cost-effectiveness analysis. Orthopaedics and Traumatology: Surgeryand Research. 2015;101(2): 147-150.
27. 28- Rodriguez-Merchan EC. Review: Musculo-skeletal manifestations of haemophilia. Blood Reviews 2016; 30: 401–409.
28. 29- Soker M. Hemophilia and Globalisation. Turkiye Klinikleri J Hem Onc-Special Topics. 2010;3(3):1-4 .
29. 30- Altintas A, Ayyildiz O, Cil T, Soker M, Muftuoglu E. Inhibitors in Hemophilia A and B in Southeast of Turkey. International Journal of Hematology and Oncology. 2018;28(4): 128-132.
30. 31- Kotela A, Wilk-Franczuk M, Zbikowski P, Legosz P, Ambrosias P, Kotela I. Revision Knee Arthroplasty in Patients with Inherited Bleeding Disorders: A Single-Center Experience. Med Sci Monit. 2017;23: 129-137.
31. 32- Zingg P O, Fucentese S F, Lutz W, Brand B, Magisch N, Koch PP. Haemophilic knee arthropathy: long-term outcome after total knee replacement. Knee Surgery, Sports Traumatology, Arthroscopy. 2012;20(12):2465-2470.
32. 33- Strauss AC, Schmolders J, Friedrich MJ, Pflugmacher R, Muller MC, Goldmann G, et al. Outcome after total knee arthroplasty in haemophilic patients with stiff knees. Haemophilia. 2015; 21(4), e300–e305.
33. 34- Aydogdu S. Hemofili Hastalarında Ortopedik Yaklaşımlar. Orthopaedic Management of Musculoskeletal Problems in Haemophiliacs. Turkiye Klinikleri J Int Med Sci. 2006;2(2):20-8.