Total Knee Arthroplasty in Severe Hemophilic Arthropathy With Stiff Knees(Preoperative Flexion Range of Motion ≤40°): Functional Outcomes and Long-Term Survivorship.

AIM: This study aimed to evaluate the clinical and radiographic outcomes of total knee arthroplasty (TKA) in patients with haemophilia A and severely stiff knees (preoperative flexion range of motion ≤40°) with a focus on functional recovery, implant stability, and complication rates.

METHODS

Twenty-four patients (31 knees) with severe haemophilia A and severely stiff knees (mean age: 38.4 years; range: 24-61 years) underwent TKA using the medial parapatellar approach and Posterior Stabilised prostheses. Knee ROM and flexion contracture were assessed preoperatively and at the latest follow-up. Radiographic analysis evaluated component stability, joint alignment, deformity correction, and postoperative complications. Long-term implant survivorship was assessed using Kaplan-Meier analysis.

RESULTS

Over an average follow-up of 7.2 years (range: 3.2-14.8 years), no cases of prosthetic loosening, instability, or axial deformity were found except in two knees. Complications occurred in three patients (9.7%): one late periprosthetic joint infection requiring revision, one superficial wound infection resolved conservatively, and one aseptic loosening requiring revision. Knee flexion improved from 42.8° to 81.3° and flexion contracture from 16.2° to 5.8° (both p < 0.001). Ten-year implant survivorship was 93.4% (95% CI: 86.1-97.2%).

CONCLUSION

TKA appears to be a safe and effective intervention for haemophilia patients with severely stiff knees, offering substantial functional recovery, enhanced joint mobility, and a low complication profile. Earlier intervention in patients with flexion >30° may optimise outcomes.