Total Hip Arthroplasty in Hemophilic Patients: are their Results Similar to those of Nonhemophilic Patients?

Document Type : In Brief


Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain



Total hip arthroplasty (THA) is the mainstay therapy for patients with terminal hemophilic arthropathy
of the hip. However, the largest case series published between 2017 and 2023 in the literature on THA 
in patients with hemophilia have found a higher 1-year infection rate (8.1% versus 3.4%) in hemophilia 
patients than in the general population, a higher rate of in-hospital bleeding complications (38.7% 
versus 16.1%), a higher length of stay (6 days versus 3 days) and a higher 30 -day readmission rate 
(22.6% versus 4.1%). Finally, a lower 5-year survival rate has also been observed in hemophilia 
patients than in the general population (91.9% versus 95.3%). In the last decade there have been 
dramatically positive improvements in implant designs and hematological treatment, and therefore it 
does not seem that THA in hemophilia is so far from that in osteoarthritic patients.
 Level of evidence: III


Main Subjects

1. Carulli C, Felici I, Martini C, et al. Total hip arthroplasty in 
haemophilic patients with modern cementless implants. J 
Arthroplasty. 2015; 30(10):1757-1760. doi: 
2. Mortazavi SJ, Daneshpoor SMM, Shafiei SH. Total hip 
arthroplasty in patients with hemophilia: what do we know? 
Arch Bone Jt Surg. 2023; 11(7):434-440. doi: 
3. Strauss AC, Rommelspacher Y, Nouri B, et al. Long-term 
outcome of total hip arthroplasty in patients with 
haemophilia. Haemophilia. 2017; 23(1):129-134. doi: 
4. Wu GL, Zhai JL, Feng B, Bian YY, Xu C, Weng XS. Total hip 
arthroplasty in hemophilia patients: a mid-term to long-term 
follow-up. Orthop Surg. 2017; 9(4):359-364. doi: 
5. Wang SH, Chung CH, Chen YC, Cooper AM, Chien WC, Pan RY. 
Does hemophilia increase risk of adverse outcomes following 
total hip and knee arthroplasty? A propensity score-matched 
analysis of a nationwide, population-based study. J 
Arthroplasty 2019; 34(10):2329-2336.e1. doi: 
6. Chiasakul T, Buckner TW, Li M, Vega R, Gimotty PA, Cuker A. Inhospital complications and readmission in patients with 
hemophilia undergoing hip or knee arthroplasty. JB JS Open 
Access 2020; 5(2):e0085. doi: 10.2106/JBJS.OA.19.00085.
7. Gillinov SM, Burroughs PJ, Moore HG, Rubin LE, Frumberg DB, 
Grauer JN. Total hip arthroplasty in patients with classic  hemophilia: a matched comparison of 90-day outcomes and 5-
year implant survival. J Arthroplasty. 2022; 37(7):1333-1337. 
doi: 10.1016/j.arth.2022.02.107.
8. Hernandez N, Kim B, Cochrane NH, Ryan SP, Seyler TM. 
Midterm results of contemporary uncemented total hip 
arthroplasty in patients 45 years or younger. Orthopedics. 
2023; 46(1):e45-e51. doi: 10.3928/01477447-20221024-04.
9. Fransen BL, Bengoa FJ, Neufeld ME, Sheridan GA, Garbuz DS, 
Howard LC. Thin highly cross-linked polyethylene liners 
combined with large femoral heads in primary total hip 
arthroplasty show excellent survival and low wear rates at a 
mean follow-up of 12.8 years. Bone Joint J. 2023; 105-
B(1):29-34. doi: 10.1302/0301-620X.105B1.BJJ-2022-
10. Chen AG, Sogbein OA, McClure JA, et al. Total hip arthroplasty 
in patients aged 40 to 60 years old: a population-based study. 
J Arthroplasty. 2023; 38(7S):S83-S88.e2. doi: 
11. Wooster BM, Kennedy NI, Dugdale EM, et al. Contemporary 
outcomes of primary total hip arthroplasty in patients with 
inflammatory arthritis. Bone Joint J. 2023; 105-B (7):768-774. 
doi: 10.1302/0301-620X.105B7.BJJ-2023-0220.R1.
12. Parilla FW, Youngman TR, Layon DR, et al. Excellent 20-year 
results of total hip arthroplasty with highly cross-linked 
polyethylene on cobalt-chromium femoral heads in patient's
≤50 years. J Arthroplasty. 2024; 39(2):409-415. doi: 
13. Parilla FW, Anthony CA, Bartosiak K, Pashos GE, Thapa S, 
Clohisy JC. Ten year outcomes of contemporary total hip 
arthroplasty in adolescent and young adult patients are 
favorable. J Arthroplasty. 2024; 39(3):754-759. doi: 
14. Ennis HE, Lamar KT, Johnson RM, Phillips JL, Jennings JM. 
Comparison of outcomes in high versus low activity level 
patients after total joint arthroplasty. J Arthroplasty. 2024; 
39(1):54-59. doi: 10.1016/j.arth.2023.06.031.