Introduction: Patients with hemophilia (PWH) constantly suffer hemarthrosis, which leads to deformity of the hip joint. There is a lack of understanding on the unusual morphology of proximal femur in PWH. To explore how does the morphology of proximal femur affect the total hip arthroplasty (THA) of PWH, we conducted a 5-year retrospective study on PWH who underwent THA.
Methods: The retrospective study comprised data of adult patients who received THA from 2018 to 2022 in the research center. Patients having a diagnosis of hemophilic arthritis and received THA were included and divided into three groups according to Dorr classification. The surgical time, surgical blood loss, laboratory examinations post-operation including hemoglobin (HB), total protein (TP), activated partial thromboplastin time (APTT), D-dimer (D2), C-reactive protein level (CRP), erythrocyte sedimentation rate (ESR), and functional evaluations 1 year after surgery including visual analogue scale (VAS), Harris hip score (HHS), range of motion (ROM) were collected. Kolmogorov-Smirnov test was used to test data normality, and t-test were performed by SPSS 20. P<0.05 was considered statistically significant.
Results: 33 PWH were included in the study and finished follow-up. All cases were male patients. Among the 33 hips, 19 (57.6%) were classified to Dorr A, and 12 (36.4%) were Dorr B, and only 2 (6%) were Dorr C. No significant difference was found in expanse, hospital stay, surgical time and total blood loss. PWH with Dorr A requires significant less coagulation factor than Dorr B and Dorr C. All Dorr types of hips presented good recovery from the surgery according to the perioperative examinations including hemoglobin (HB), total protein (TP), activated partial thromboplastin time (APTT), D-dimer (D2), C-reactive protein level (CRP), erythrocyte sedimentation rate (ESR) and thigh circumference (TC). The 2-year follow-up demonstrated favorable functional rehabilitation according to functional evaluations including visual analogue scale (VAS), Harris hip score (HHS)) and range of motion (ROM).
Conclusion: In this study, we found that PWH tend to have more Dorr A than the normal. PWH with Dorr A requires smaller dosage to maintain the coagulation factor activity than the Dorr B and Dorr C. Additionally, all types of hip presented good recovery after THA. Finally, THA is an effective treatment for PWH with all Dorr classifications by alleviating the pain and improve the motor function.