Various Surgical Treatment of Hemophilic Pseudotumor : A Case Series

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedic and Traumatology Dr.Cipto Mangunkusumo General Hospita, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia Integrated Hamophillia TeamDr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

2 Department of Orthopaedic and Traumatology Dr.Cipto Mangunkusumo General Hospita, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

3 Department of Internal Medicine Dr.Cipto Mangunkusumo General Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia Integrated Hamophillia TeamDr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

4 Department of Paediatric Dr.Cipto Mangunkusumo General Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia Integrated Hamophillia Team, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia

Abstract

Background: Bleeding episodes in severe hemophilia may occur more frequently and spontaneously after mild
trauma or daily activities. An inadequate treatment of that bleeding in hemophilia may result in pseudotumor,
usually in the muscle adjacent to the bone. We reported haemophilic pseudotumor treated with various surgical
interventions.
Methods: This study was conducted inthe Department of Orthopaedic and Traumatology at a government hospital
over a period of 7 years(2010 –2017). Patients Perioperative management was done in accordance with the Integrated
Hemophilia Team of our institution protocol.Diagnosis and management planning of hemophilic pseudotumor was
confirmed via Integrated HemophiliaTeam meeting. After the surgery, all patients were asked to come for routine
follow up.
Results: We reported six Haemophilia-A patients with pseudotumor in the pelvis, proximal femur and lower
leg. One case in pelvic bone underwent hematoma evacuation, acetabular reconstruction using the Harrington
procedure, and total hip arthroplasty.Two cases, a case in the proximal femur and another case in the distal fibula,
were treated with amputation, other two cases, one was soft tissue psedotumor in the pelvic region and was
treated by hematoma evacuation, and the remaining casewas managed with wide excision and followed by defect
closure.
Conclusion: Surgery is a preferable treatment for pseudotumors that have been present for years.It’s associated
with the best outcomes especially when selected as the primary line ofwith preventable and manageable bleeding
complication. As previously published by many authors, this paper confirms that surgical excision is the treatment of
choice but should only be carried out in major hemophilia centers by a multidisciplinary surgical team.
Level of evidence: IV

Keywords

Main Subjects

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The Archives of Bone and Joint Surgery
Volume 7, Issue 6
November 2019
Pages 514-522

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History

  • Receive Date: 07 September 2018
  • Revise Date: 04 October 2018
  • Accept Date: 06 October 2018

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