Bilateral total knee replacement for hemophilic arthropathy: a case report

Von Willebrand disease (vWD) and hemophilia present unique challenges in orthopedic surgery due to their inherent bleeding risks and potential complications. While joint bleedings are well-documented in hemophilia, they are less understood in vWD, especially regarding their impact on daily activities and the development of arthropathy. We present a case of a young female patient aged 25 years with vWD Type 3 who underwent bilateral total knee replacement (TKR) due to end-stage knee osteoarthritis. Following two previous operations of the right knee at the age of 14, the patient had high degree of extra-articular valgus and intra-articular deformity, ankylosed knee in 30^o flexion, osteopenia, and chronic patellar dislocation. Bilateral TKR was performed using patient-specific templating (PST) technology, which includes preoperative planning using a CT scan followed by surgical execution. Financial constraints and limited prosthetic resources necessitated a sequential approach to TKR, addressing the more affected right knee first. Despite many challenges, successful outcomes were achieved, with significant improvements in pain, mobility, overall satisfaction, and no complications at two-year follow-up. Our case highlights the importance of individualized treatment strategies, meticulous surgical planning, and postoperative care in managing knee arthropathy patients with bleeding disorders.