Extension contracture stiff knee in haemophilia: Surgical timing and procedure for total knee arthroplasty

Abstract

Introduction: Total knee arthroplasty (TKA) for a stiff knee of patients with haemophilia (PWH) represents a challenge for orthopaedic surgeons for the difficulties of exposing the knee and high complication rate compared to a flexible knee.

Aim: To optimize the surgical exposure in primary TKA for PWH and to propose a threshold angle of extension contracture in treating haemophilic knee joints, retrospectively.

Methods: Sixty-seven primary TKAs for PWH (mean age, 48 years) were performed, and incisional approaches to joint were standard (58 cases) and V-Y quadricepsplasty (V-Y) (9 cases). The decision of surgical approach was decided intraoperatively by two surgeons. Pre- and post-knee angles were evaluated in each group. Variables in the V-Y group were evaluated using univariate logistic regression analysis and receiver operating characteristic curve analysis.

Results: Univariate logistic regression analysis demonstrated that the preoperative range of motion (ROM) and flexion were significantly associated with V-Y. Threshold values of preoperative flexion and ROM resulting in V-Y using receiver operating characteristic analysis were 45° and 35°, respectively.

Conclusions: Primary TKA for PWH using a standard approach may be performed before the stage preoperative flexion <45° and ROM <35°.

Keywords: Haemophilia; V-Y quadricepsplasty; extension contracture; stiff knee; total knee arthroplasty.