Special features of total knee replacement in hemophilia.

Total knee replacement is an operation frequently needed by hemophilia patients, which greatly improves their quality of life. This operation, however, carries a higher risk of bleeding and infection for hemophiliacs than it does for osteoarthritis sufferers. It is advisable to implant prosthetic components using antibiotic-loaded cement.

Acute compartment syndrome in haemophilia.

Acute compartment syndrome (ACS) is characterized by an increase in pressure (intramuscular pressure) within a muscle compartment, which reduces capillary perfusion threatening tissue survival. Persistence of this increased pressure for a few hours will result in necrosis of muscle and nerve tissue, with contracture in the affected limb and permanent loss of function. For that reason, early treatment and diagnosis of ACS is fundamental.

Haemophilic synovitis of the elbow: radiosynovectomy, open synovectomy or arthroscopic synovectomy?

Arthroscopic synovectomy (AS) of the elbow, while providing similar pain relief to open synovectomy (OS), may place patients at higher risk for recurrence. The primary predictor of outcome is degree of pre-existing degenerative changes within the joint. Regarding haemophilia patients, radiosynovectomy (RS) is the best choice for patients with persistent synovitis of the elbow.

Radiosynovectomy: review of the literature and report from two haemophilia treatment centers.

Haemophilic arthropathy occurs due to recurrent bleeding into joints leading to swelling, inflammation, destruction of cartilage and bone, and development of arthritis. Although prophylactic replacement therapy assists in preventing arthropathy, it is not always adequate or affordable. Radiosynovectomy is a minimally invasive intervention for treatment of synovitis in haemophilic joints.

Orthopedic surgery is possible in hemophilic patients with inhibitors.

Hemophilia is an inherited recessive sex-linked bleeding disorder. An insufficiency of coagulation factor VIII produces hemophilia A, and lack of factor IX causes hemophilia B. Prevention and management of the disease require intravenous infusion of the deficient factor.

Pseudoaneurysms in haemophilia.

The incidence of bleeding as a result of a pseudoaneurysm in haemophilia is very low. The diagnosis should be suspected if the patient has a history of arterial trauma. Pseudoaneurysms can appear anywhere where trauma occurs.

The treatment of patellar tendinopathy.

Background: Patellar tendinopathy (PT) presents a challenge to orthopaedic surgeons. The purpose of this review is to revise strategies for treatment of PT MATERIALS AND METHODS: A PubMed (MEDLINE) search of the years 2002-2012 was performed using "patellar tendinopathy" and "treatment" as keywords. The twenty-two articles addressing the treatment of PT with a higher level of evidence were selected.

Regeneration of articular cartilage of the knee.

Cartilage therapy for focal articular lesions of the knee has been implemented for more than a decade, and it is becoming increasingly available. What do we know on the healing response of cartilage lesions? What do we know on the treatment of focal cartilage lesions of the knee and the prognostic factors involved? PubMed articles related to articular cartilage regeneration of the knee in clinical studies were searched from January 2006 to November 2012, using the following key words: articular cartilage, regeneration, clinical studies, and knee. A total of 44 reports were found.

Consecutive radiosynovectomy procedures at 6-monthly intervals behave independently in haemophilic synovitis.

Background: Previous studies on the same group of patients investigated here demonstrated the effectiveness of radiosynovectomy in the treatment of chronic haemophilic synovitis even if one, two or three radiosynovectomy procedures (RS-1, RS-2, RS-3) may be necessary. The purpose of this study was to determine whether the joints' response to each radiosynovectomy procedure behaved independently or not.

Materials And Methods: One hundred and fifty-six radiosynovectomies were performed in 104 joints of 78 people diagnosed with chronic haemophilic synovitis.

The role of physical medicine and rehabilitation in haemophiliac patients.

Physical medicine and rehabilitation aim to evaluate, diagnose and treat disability in haemophiliac patients, while preventing injury or deterioration. They also aim to maintain the greatest degree of functional capacity and independence in patients with haemophilia, or to return them to that state. Rehabilitation, together with clotting factor replacement therapy, has revolutionized the management of these patients in developed countries and reduced their morbidity/mortality rates.

Instability following total knee arthroplasty.

Background Knee prosthesis instability (KPI) is a frequent cause of failure of total knee arthroplasty. Moreover, the degree of constraint required to achieve immediate and long-term stability in total knee arthroplasty (TKA) is frequently debated. Questions This review aims to define the problem, analyze risk factors, and review strategies for prevention and treatment of KPI.

Consensus recommendations for the use of FEIBA(®) in haemophilia A patients with inhibitors undergoing elective orthopaedic and non-orthopaedic surgery.

A growing number of publications have described the efficacy and safety of FEIBA as a first-line haemostatic agent for surgical procedures in haemophilia A patients with high-responding FVIII inhibitors. The aim of this study was to provide practical guidance on patient management and selection and also to communicate a standardized approach to the dosing and monitoring of FEIBA during and after surgery. A consensus group was convened with the aims of (i) providing an overview of the efficacy and safety of FEIBA in surgery; (ii) sharing best practice; (iii) developing recommendations based on the outcome of (i) and (ii).

Orthopaedic co-morbidities in the elderly haemophilia population: a review.

Due to improvements in the treatment and medical care of haemophilia, the life expectancy of individuals with haemophilia has approached that of the general population. To review the main co-morbidities of the musculoskeletal system in elderly persons with haemophilia, we have performed a review of the literature on the musculoskeletal problems of elderly haemophiliacs. Chronic arthropathy is the main co-morbidity in the ageing person with haemophilia.

Review article: Risk factors of infection following total knee arthroplasty.

22 PubMed articles in English were identified using the key words: 'risk factors', 'infection', and 'primary total knee arthroplasty (TKA)'. The 10 most relevant articles were reviewed. In one study, obesity and diabetes were considered risk factors for infection following TKA.

Intra-articular injections of hyaluronic acid (viscosupplementation) in the haemophilic knee.

Intra-articular injections (IAIs) of hyaluronic acid, also called viscosupplementation, can be used for the treatment of radiological haemophilic arthropathy of the knee, that is when mild-to-moderate degenerative changes can be visualized on plain radiographs. This article aims to define the efficacy of IAIs of hyaluronic acid in the treatment of radiological haemophilic arthropathy of the knee. A review of recent literature on the topic has been performed.

Differing approaches to diagnosis and treatment of musculoskeletal complications of haemophilia in resource-rich and resource-limited settings.

Management of the musculoskeletal complications of haemophilia should be consistent in both RRS (resource-rich settings) and RLS (resource-limited settings). Due to the lack of available resources in RLS, physicians face challenges that may limit their options for procedures. This article aimed to define the role of different techniques for the management of the musculoskeletal complications of haemophilia in RRS and RLS.

Orthopaedic problems about the ankle in hemophilia.

Hemophilia is an inherited recessive, sex-linked bleeding disorder. The lack of sufficient coagulation factor VIII produces hemophilia A, and the lack of factor IX causes hemophilia B. The prevention and treatment of the disease requires intravenous infusion of the deficient factor.

Prevention of the musculoskeletal complications of hemophilia.

Hemophilia is an inherited disorder of clotting factor deficiencies resulting in musculoskeletal bleeding, including hemarthroses, leading to musculoskeletal complications. The articular problems of hemophiliac patients begin in infancy. These include: recurrent hemarthroses, chronic synovitis, flexion deformities, hypertrophy of the growth epiphyses, damage to the articular cartilage, and hemophilic arthropathy.

The treatment of cartilage defects in the knee joint: microfracture, mosaicplasty, and autologous chondrocyte implantation.

The efficacy of microfracture (MF), mosaicplasty (MO), and autologous chondrocyte implantation (ACI) techniques are still a matter of debate. This review aims to analyze comparative studies of these techniques, review the results of no treatment, and the natural history of untreated articular cartilage lesions. A PubMed search on the topic was performed.

Local fibrin glue and chitosan-based dressings in haemophilia surgery.

Fibrin glue and chitosan-based dressings (CBDs) could be useful local haemostatic agents for severe haemorrhage in persons with haemophilia undergoing surgical procedures. The aim of the present study was to clarify the role of fibrin glue and CBDs in persons with haemophilia. A review of the most recent literature on the topic was performed.

Preventing surgical site infection in haemophilia patients undergoing total knee arthroplasty.

Unlabelled: The rate of infection following primary total knee arthroplasty (TKA) in the general population is 1% on average. However, in persons with haemophilia (PWH), the mean rate of infection following primary TKA is nearly 8%.

Questions: why is the infection rate higher in persons with haemophilia compared with the general population? what should be done to correct this? A PubMed (MEDLINE) search and a Cochrane Library search were performed.