Effectiveness of condylar constrained knee prosthesis for destructive hemophilic arthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

BIAN Yanyan , ZHAI Jiliang , PENG Huiming ,  WENG Xisheng , LIN Jin , JIN Jin , QIAN Wenwei , ZHAO Lijuan

Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, P.R.China;

Corresponding?author：

WENG Xisheng, Email: xshweng@medmail.com.cn

Keywords：

Hemophilia; condylar constrained knee prosthesis; total knee arthroplasty

DOI：

10.7507/1002-1892.201609108

Video：

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Objective To investigate the clinical outcomes of total knee arthroplasty (TKA) by using the condylar constrained knee prosthesis in the treatment of destructive hemophilic arthritis. Methods Between September 2007 and July 2015, 8 cases (8 knees) of destructive hemophilic arthritis accepted TKA by using condylar constrained knee prosthesis. All patients were male, aged 22 to 56 years, with an average age of 35 years. The disease course of hemophilia A was 3-30 years (mean, 17.3 years). Preoperative range of motion (ROM) was (68.1±32.6)°; the flexion deformity was (14.38±16.13)°. Six patients had valgus of 7-35° (mean, 17.3°), of whom, one had fixed dislocation of patella; and one had varus of 15°. Hospital for Special Surgery (HSS) knee score was 52.5±12.9. Pre-operative X-ray film examination demonstrated narrowing of the knee gap and cystic degeneration of articular cartilage and subchondral bone. Results All patients achieved primary wound healing, and were followed up 1-9 years (mean, 5 years). Tense blister with common peroneal nerve damage and extension penetrating into distal tibial cortex occurred in 1 case respectively, which were cured corresponding treatment. At last follow-up, the knee ROM and the flexion deformity were significantly improved to (98.1±8.9)° and (0.63±1.77)° (t=–2.527,P=0.036;t=2.396,P=0.047). At 2 weeks after operation and last follow-up, the HSS scores were significantly increased to 77.3±11.0 and 85.0±9.0 (P<0.05). X-ray film showed that lower extremity alignment returned to normal in patients with varus and valgus. Conclusion Good curative effect can be get by using condylar constrained knee prosthesis in TKA for the treatment of destructive hemophilic arthritis.

Citation： BIAN Yanyan, ZHAI Jiliang, PENG Huiming, WENG Xisheng, LIN Jin, JIN Jin, QIAN Wenwei, ZHAO Lijuan. Effectiveness of condylar constrained knee prosthesis for destructive hemophilic arthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(3): 266-270. doi: 10.7507/1002-1892.201609108 Copy

1.	??ztürk, A, Akalin Y, ?evik N,et al. Posterior cruciate-substituting total knee replacement recovers the flexion arc faster in the early postoperative period in knees with high varus deformity: a prospective randomized study. Arch Orthop Trauma Surg, 2016, 136(7): 999-1006.
2.	Oliviu RC, Zazgyva A, Septimiu S, et al. Mid-term results of total knee replacement with single-radius versus multi-radius posterior-stabilized implants. Acta Orthop Traumatol Turc, 2016, 50(2): 125-131.
3.	Clatworthy M. Total Knee Replacement Plus Nonsurgical Treatment Was Better Than Nonsurgical Treatment Alone for Knee Osteoarthritis. J Bone Joint Surg (Am), 2016, 98(10): 873.
4.	Liao CY, Chan HT, Chao E, et al. Comparison of total hip and knee joint replacement in patients with rheumatoid arthritis and osteoarthritis: a nationwide, population-based study. Singapore Med J, 2015, 56(1): 58-64.
5.	Luque R, Rizo B, Urda A, et al. Primary modular total knee replacement in severe and unstable osteoarthritis. Predictive factors for failure. Int Orthop, 2015, 39(11): 2125-2133.
6.	Touzopoulos P, Drosos GI, Ververidis A, et al. Constrained Implants in Total Knee Replacement. Surg Technol Int, 2015, 26: 307-316.
7.	Frikha F, Marzouk S, Kaddour N, et al. Destructive arthritis in Behcet’s disease: a report of eight cases and literature review. Int J Rheum Dis, 2009, 12(3): 250-255.
8.	張卓, 關振鵬, 孫鐵錚, 等. 血友病患者全膝置換圍手術期的凝血因子替代治療. 中國組織工程研究與臨床康復, 2011, 15(22): 4023-4027.
9.	何超, 劉茂林, 張華文. 血友病性骨關節病影像學表現 (附 20 例分析). 實用放射學雜志, 2009. 25(9): 1294-1296.
10.	徐瑞燚, 趙永強, 康增壽, 等.³²磷膠體滑膜切除術治療慢性血友病滑膜炎. 血栓與止血學, 2003, 9(2): 56-57, 60.
11.	李培勇, 陳剛, 張立穎, 等. 血友病關節炎的¹⁸⁸Re-硫化錸放射性滑膜切除研究. 中華血液學雜志, 2002, 23(3): 151-152.
12.	Zhang WQ, Han SQ, Yuan Z, et al. Effects of intraarticular (32)P colloid in the treatment of hemophilic synovitis of the knee: A short term clinical study. Indian J Orthop, 2016, 50(1): 55-58.
13.	Gilbert MS, Radomisli TE. Therapeutic options in the management of hemophilic synovitis. Clin Orthop Relat Res, 1997, (343): 88-92.
14.	Rodriguez-Merchan EC, Gomez-Cardero P. Arthroscopic knee debridement can delay total knee replacement in painful moderate haemophilic arthropathy of the knee in adult patients. Blood Coagul Fibrinolysis, 2016, 27(6): 645-647.
15.	Rodríguez-Merchán EC, Magallón M, Galindo E, et al. Hamstring release for fixed knee flexion contracture in hemophilia. Clin Orthop Relat Res, 1997, (343): 63-67.
16.	Wallny T, Eickhoff HH, Raderschadt G, et al. Hamstring release and posterior capsulotomy for fixed knee flexion contracture in haemophiliacs. Haemophilia, 1999, 5 Suppl 1: 25-27.
17.	Kiely PD, McMahon C, Smith OP, et al. The treatment of flexion contracture of the knee using the Ilizarov technique in a child with haemophilia B. Haemophilia, 2003, 9(3): 336-339.
18.	李其一, 翁習生, 秦泗河, 等. 改良 Illzarov 技術矯治血友病兒童雙膝關節重度屈曲畸形. 中國骨與關節外科, 2011, 4(5): 422-425.
19.	馮賓, 翁習生, 林進, 等. 全膝關節置換術治療甲型血友病性膝關節病變的療效分析. 中華骨科雜志, 2010, 30(4): 363-368.
20.	童培建, 李陶冶, 俞楠澤, 等. 全膝關節置換術治療甲型血友病性膝關節炎的短期療效分析. 中華外科雜志, 2010, 48(10): 796-797.
21.	閆偉強, 賀西京, 張敏, 等. 全膝關節置換術治療重型血友病性膝關節炎的臨床研究. 中國骨與關節損傷雜志, 2013, 28(2): 153-154.
22.	高增鑫, 邱貴興, 翁習生, 等. 關節成形術治療血友病性關節病. 中華外科雜志, 2008, 46(11): 809-812.
23.	劉珂, 鄭稼, 金毅, 等. 髁限制性膝關節假體在膝關節翻修中的臨床應用研究. 中國實用醫刊, 2013, 40(11): 27-29.
24.	彭慧明, 翁習生, 林進, 等. 初次全膝關節置換術后腓總神經麻痹的原因及處理. 中國骨與關節外科, 2010, 3(3): 198-203.
25.	馮賓, 翁習生, 林進, 等. 血友病性骨關節病變的外科治療策略. 中華骨科雜志, 2016, 36(7): 413-421.

1. ??ztürk, A, Akalin Y, ?evik N,et al. Posterior cruciate-substituting total knee replacement recovers the flexion arc faster in the early postoperative period in knees with high varus deformity: a prospective randomized study. Arch Orthop Trauma Surg, 2016, 136(7): 999-1006.
2. Oliviu RC, Zazgyva A, Septimiu S, et al. Mid-term results of total knee replacement with single-radius versus multi-radius posterior-stabilized implants. Acta Orthop Traumatol Turc, 2016, 50(2): 125-131.
3. Clatworthy M. Total Knee Replacement Plus Nonsurgical Treatment Was Better Than Nonsurgical Treatment Alone for Knee Osteoarthritis. J Bone Joint Surg (Am), 2016, 98(10): 873.
4. Liao CY, Chan HT, Chao E, et al. Comparison of total hip and knee joint replacement in patients with rheumatoid arthritis and osteoarthritis: a nationwide, population-based study. Singapore Med J, 2015, 56(1): 58-64.
5. Luque R, Rizo B, Urda A, et al. Primary modular total knee replacement in severe and unstable osteoarthritis. Predictive factors for failure. Int Orthop, 2015, 39(11): 2125-2133.
6. Touzopoulos P, Drosos GI, Ververidis A, et al. Constrained Implants in Total Knee Replacement. Surg Technol Int, 2015, 26: 307-316.
7. Frikha F, Marzouk S, Kaddour N, et al. Destructive arthritis in Behcet’s disease: a report of eight cases and literature review. Int J Rheum Dis, 2009, 12(3): 250-255.
8. 張卓, 關振鵬, 孫鐵錚, 等. 血友病患者全膝置換圍手術期的凝血因子替代治療. 中國組織工程研究與臨床康復, 2011, 15(22): 4023-4027.
9. 何超, 劉茂林, 張華文. 血友病性骨關節病影像學表現 (附 20 例分析). 實用放射學雜志, 2009. 25(9): 1294-1296.
10. 徐瑞燚, 趙永強, 康增壽, 等.³²磷膠體滑膜切除術治療慢性血友病滑膜炎. 血栓與止血學, 2003, 9(2): 56-57, 60.
11. 李培勇, 陳剛, 張立穎, 等. 血友病關節炎的¹⁸⁸Re-硫化錸放射性滑膜切除研究. 中華血液學雜志, 2002, 23(3): 151-152.
12. Zhang WQ, Han SQ, Yuan Z, et al. Effects of intraarticular (32)P colloid in the treatment of hemophilic synovitis of the knee: A short term clinical study. Indian J Orthop, 2016, 50(1): 55-58.
13. Gilbert MS, Radomisli TE. Therapeutic options in the management of hemophilic synovitis. Clin Orthop Relat Res, 1997, (343): 88-92.
14. Rodriguez-Merchan EC, Gomez-Cardero P. Arthroscopic knee debridement can delay total knee replacement in painful moderate haemophilic arthropathy of the knee in adult patients. Blood Coagul Fibrinolysis, 2016, 27(6): 645-647.
15. Rodríguez-Merchán EC, Magallón M, Galindo E, et al. Hamstring release for fixed knee flexion contracture in hemophilia. Clin Orthop Relat Res, 1997, (343): 63-67.
16. Wallny T, Eickhoff HH, Raderschadt G, et al. Hamstring release and posterior capsulotomy for fixed knee flexion contracture in haemophiliacs. Haemophilia, 1999, 5 Suppl 1: 25-27.
17. Kiely PD, McMahon C, Smith OP, et al. The treatment of flexion contracture of the knee using the Ilizarov technique in a child with haemophilia B. Haemophilia, 2003, 9(3): 336-339.
18. 李其一, 翁習生, 秦泗河, 等. 改良 Illzarov 技術矯治血友病兒童雙膝關節重度屈曲畸形. 中國骨與關節外科, 2011, 4(5): 422-425.
19. 馮賓, 翁習生, 林進, 等. 全膝關節置換術治療甲型血友病性膝關節病變的療效分析. 中華骨科雜志, 2010, 30(4): 363-368.
20. 童培建, 李陶冶, 俞楠澤, 等. 全膝關節置換術治療甲型血友病性膝關節炎的短期療效分析. 中華外科雜志, 2010, 48(10): 796-797.
21. 閆偉強, 賀西京, 張敏, 等. 全膝關節置換術治療重型血友病性膝關節炎的臨床研究. 中國骨與關節損傷雜志, 2013, 28(2): 153-154.
22. 高增鑫, 邱貴興, 翁習生, 等. 關節成形術治療血友病性關節病. 中華外科雜志, 2008, 46(11): 809-812.
23. 劉珂, 鄭稼, 金毅, 等. 髁限制性膝關節假體在膝關節翻修中的臨床應用研究. 中國實用醫刊, 2013, 40(11): 27-29.
24. 彭慧明, 翁習生, 林進, 等. 初次全膝關節置換術后腓總神經麻痹的原因及處理. 中國骨與關節外科, 2010, 3(3): 198-203.
25. 馮賓, 翁習生, 林進, 等. 血友病性骨關節病變的外科治療策略. 中華骨科雜志, 2016, 36(7): 413-421.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of condylar constrained knee prosthesis for destructive hemophilic arthritis

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