open access

Vol 8, No 1 (2015)
Review paper
Published online: 2015-03-24
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Possibilities and perspectives in orthopaedic treatment of articular changes related to inherited clotting factor deficiencies

Piotr Żbikowski, Paweł Ambroziak, Andrzej Kotela, Ireneusz Kotela
Journal of Transfusion Medicine 2015;8(1):3-11.

open access

Vol 8, No 1 (2015)
REVIEWS
Published online: 2015-03-24

Abstract

Recurrent intraarticular bleeds in patients with inherited clotting disorders inevitably lead to their impairment and major disability. Direct toxic effect of blood, mostly that of iron ions, on cartilage as well as synovium overgrowth contribute to arthropathy pathogenesis. Most effective for arthropathy prevention is prophylaxis with concentrates of deficient clotting factors. Nonoperative treatment of affected joints is based on physiotherapy. In cases of marked synovium overgrowth radiosynovectomy is helpful for reducing the number of bleeds. In cases of advanced joint destruction surgery is performed. In knees and hips total joint replacement is most frequent. Fusion is usually chosen for ankles but attempts at joint replacement are becoming more frequent. Elbows are rarely addressed and the most popular procedure is resection of radial head with open synovectomy. There are incidental reports of total elbow replacement in this group of patients. In general, for patients with clotting disorders the results of operative treatment are inferior to those performed in patients with degenerative arthritis. Modern techniques of cartilage reconstruction which are based on bone marrow stimulation or bioengineering have not been proved effective in haemophilic arthropathy.

Abstract

Recurrent intraarticular bleeds in patients with inherited clotting disorders inevitably lead to their impairment and major disability. Direct toxic effect of blood, mostly that of iron ions, on cartilage as well as synovium overgrowth contribute to arthropathy pathogenesis. Most effective for arthropathy prevention is prophylaxis with concentrates of deficient clotting factors. Nonoperative treatment of affected joints is based on physiotherapy. In cases of marked synovium overgrowth radiosynovectomy is helpful for reducing the number of bleeds. In cases of advanced joint destruction surgery is performed. In knees and hips total joint replacement is most frequent. Fusion is usually chosen for ankles but attempts at joint replacement are becoming more frequent. Elbows are rarely addressed and the most popular procedure is resection of radial head with open synovectomy. There are incidental reports of total elbow replacement in this group of patients. In general, for patients with clotting disorders the results of operative treatment are inferior to those performed in patients with degenerative arthritis. Modern techniques of cartilage reconstruction which are based on bone marrow stimulation or bioengineering have not been proved effective in haemophilic arthropathy.

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Keywords

hereditary coagulation disorder, arthropathy, replacement

About this article
Title

Possibilities and perspectives in orthopaedic treatment of articular changes related to inherited clotting factor deficiencies

Journal

Journal of Transfusion Medicine

Issue

Vol 8, No 1 (2015)

Article type

Review paper

Pages

3-11

Published online

2015-03-24

Bibliographic record

Journal of Transfusion Medicine 2015;8(1):3-11.

Keywords

hereditary coagulation disorder
arthropathy
replacement

Authors

Piotr Żbikowski
Paweł Ambroziak
Andrzej Kotela
Ireneusz Kotela

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