Primary Total Knee Arthroplasty in Hemophilia and Allied Disorders: Revision Rates and Their Causes

Document Type : In Brief


Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain



When patients with hemophilia and allied disorders (von Willebrand disease and other congenital 
bleeding disorders) do not receive adequate primary hematologic prophylaxis from infancy, their joints 
will suffer knee joint degeneration; when such joint degeneration becomes very advanced (painful and 
disabling) despite previous conservative treatment, the only way to alleviate the problem will be to 
implant a primary total knee arthroplasty (TKA). The literature has shown that twenty years after 
implantation, 71% of primary TKAs are still functional; on the other hand, 18% have to be revised as a 
consequence of periprosthetic joint infection (PJI). The main causes of revision total knee arthroplasty 
are PJI and aseptic loosening (39% each).
 Level of evidence: III


Main Subjects

1. Li Z, Feng B, Du Y, Wang Y, Bian Y, Weng X. Complications of 
total knee arthroplasty in patients with haemophilia 
compared with osteoarthritis and rheumatoid arthritis: A 20-
year single-surgeon cohort. Haemophilia. 2020; 26(5):861-
866. doi: 10.1111/hae.14115.
2. Ernstbrunner L, Hingsammer A, Catanzaro S, et al. Long-term 
results of total knee arthroplasty in haemophilic patients: an 
18‑year follow-up. Knee Surg Sports Traumatol Arthrosc 
2017: 25(11):3431-3438. doi: 10.1007/s00167-016-4340-6.
3. Song SJ, Bae JK, Park CH, Yoo MC, Bae DK, Kim KI. Mid-term 
outcomes and complications of total knee arthroplasty in 
haemophilic arthropathy: a review of consecutive 131 knees 
between 2006 and 2015 in a single institute. Haemophilia 
2018; 24(2):299-306. doi: 10.1111/hae.13383.
4. Santos Silva M, Rodriguez-Pinto R, Rodrigues C, Morais S, Costa 
e Castro J. Long-term results of total knee arthroplasty in 
hemophilic arthropathy. J Orthop Surg (Hong Kong). 2019; 
27(1):2309499019834337. doi: 
5. Bae J-K, Kin K-I, Lee S-H, Yoo M-C. Mid-to long-term survival of 
total knee arthroplasty in hemophilic arthropathy. J Clin Med. 
2020; 9:3247. doi: 10.3390/jcm9103247.
6. Kocaoğlu H, Hennes F, Abdelaziz H, Sandiford NA, Gehrke T, 
Citak M. Do patients with von Willebrand disease exhibit 
higher blood loss and revision rates in hip and knee 
arthroplasty? A case-control study. Haemophilia.2020; 
26(3):513-519. doi: 10.1111/hae.13962.
7. Oyarzun A, Barrientos C, Barahona M, Martinez A, SotoArellano V, Courtin C, et al. Knee haemophilic arthropathy 
care in Chile: Midterm outcomes and complications after total 
knee arthroplasty. Haemophilia. 2020; 26(6):e179-e186. doi: 
8. Goker B, Caglar O, Kinikli GI, Aksu S, Tokgozoglu AM, Atilla B. 
Postoperative bleeding adversely affects total knee 
arthroplasty outcomes in hemophilia. Knee. 2022; 39:261-
268. doi: 10.1016/j.knee.2022.10.001. 
9. Carulli C, Innocenti M, Tambasco R, Perrone A, Civinini R.Total 
knee arthroplasty in haemophilia: long-term results and 
survival rate of a modern knee implant with an oxidized 
zirconium femoral component. J Clin Med. 2023; 12:4356. 
doi: 10.3390/jcm12134356.
10. Feng B, Wang Y, Dong X, Li Z, Lin J, Weng X. Long-term clinical 
outcomes following total knee arthroplasty in patients with 
hemophilic arthropathy: a single-surgeon cohort after a 10-
to 17-year follow-up. Chi Med J (English). 
2023;136(12):1478-1484. doi: 
11. Liu Y, Liu Y-F, Meng H-Z, Sun T, Gao P, Li Z-Z, et al. Total knee 
arthroplasty exhibits satisfactory long-term clinical efficacy in 
the treatment of hemophilia patients with stiff knees. Front 
Surg. 2023; 9:1014844. doi: 10.3389/fsurg.2022.1014844.