Peculiarities of total knee arthroplasty in patients with hemophilic arthropathy

Annotation. There is a wide variety of clinical manifestations of hemophilia, but one of the most frequent is spontaneous intra-articular bleeding. It accounts for more than 90% of serious bleeding in patients with severe hemophilia. almost all patients with a severe form of hemophilia have damage to large joints in the form of hemophilic arthropathy, up to 90% of such patients require orthopedic assistance in the form of total joint replacement. The purpose of this study was to highlight one's own experience of performing total joint replacement in patients with hemophilia, their rehabilitation and hemostatic support during the stages of treatment. To perform our study, we analyzed the treatment of 34 patients with hemophilia who underwent total knee arthroplasty. Among the patients of the observation array, fibrosis of the synovial membrane of the knee joint was determined in 55.9% of cases. In 85.3% of patients, cicatricial changes in the medial and lateral surface of the patella were noted during access, which led to a decrease in patellofemoral mobility. In 17.6% of patients, during access, folds of the synovial membrane were found, which were returned to the joint cavity, which led to blockages during active movements. All patients underwent subtotal synovectomy during access to the joint. This was done not only to facilitate access to the bone structures of the knee joint, but also to prevent future bleeding. In 3 patients (8.8%) quadriceps plasty was performed to adequately expose bone tissue in the joint. In 1 patient (2.9%) in a similar situation with difficult access, we performed quadriceps dissection and osteotomy of the tibial tubercle. The conducted study indicated that total hip arthroplasty is the gold standard in the treatment of patients with hemophilic knee arthropathy. Endoprosthesis of the knee joint in patients with hemophilia can effectively reduce the arthralgic syndrome in the knee joint, increase the range of motion, and improve gait function. The use of combined replacement therapy during knee replacement surgery helps to reduce blood loss and allows patients to return to an active life. The results of knee arthroplasty in patients with hemophilia require further study in the longer term after surgery.