Surgical Outcomes, Complications, and Cost-Effectiveness of Total Knee Arthroplasty in Hemophilic Versus Non-Hemophilic Patients: A Comparative Study

Background: Total knee arthroplasty (TKA) is the gold standard for advanced hemophilic arthropathy. However, surgical management in hemophilic patients is complex due to joint deformities, bleeding risk, and systemic comorbidities. This study aimed to compare the surgical outcomes and cost-effectiveness of TKA in hemophilic versus non-hemophilic patients. Methods: This prospective study included 50 patients treated between 2010 and 2024 at Elias University Hospital, Romania. Group 1 included 20 male patients with severe hemophilia (2 with inhibitors); Group 2 included 30 non-hemophilic male patients. Data collection was standardized and conducted preoperatively, at 6 and 12 months postoperatively, and annually thereafter for up to 14 years following surgery. The mean follow-up duration across the cohort was 7.3 ± 3.9 years (range: 0.5–14 years), allowing for consistent long-term evaluation of clinical and functional outcomes. Study included operative time, transfusion requirements, hospitalization length, perioperative complications, functional outcomes (Knee Society Score—KSS), quality of life (EQ-5D), and cost per quality-adjusted life year (QALY). Results: Hemophilic patients had significantly longer operative times (154.5 vs. 88.7 min; p < 0.001), higher transfusion rates (45% vs. 20%, p < 0.047), and longer hospital stays (mean 12.3 vs. 6.6 days). Perioperative complications occurred in 90% of hemophilic patients (anemia requiring transfusion: 45%; compressive hematomas: 10%; wound dehiscence: 15%) compared to 10% in controls. Non-hemophilic patients achieved superior postoperative functional scores. Mean preoperative KSS was 32.25 ± 11.24 and postoperatively, the mean score increased to 98 ± 1.34. The mean preoperative KSS in the hemophilic group was 31 ± 13.93 and postoperative KSS was 74.5 ± 19.92. The cost per QALY was €2506 in the hemophilic group versus €1258 in controls. The economic assessment was conducted from the hospital perspective, focusing on direct medical costs incurred during hospitalization and the perioperative period. Cost components included factor replacement therapy, surgical and anesthesia costs, hospital stay, laboratory investigations, blood transfusions, and management of postoperative complications. Conclusion: Although TKA improves quality of life and function in hemophilic patients, it is associated with higher complication rates and costs. These findings highlight the need for careful patient selection and informed consent when considering TKA in hemophilic patients.