Elective orthopedic surgery for hemophilia patients with inhibitors: New opportunities.

We report a series of 108 elective orthopedic surgical procedures in hemophilia patients with inhibitors, comprising 88 cases in which radiosynoviorthesis was performed and 20 cases in which major orthopedic procedures were carried out. Hemostatic cover was provided by recombinant factor VIIa (rFVIIa, NovoSeven(R), Novo Nordisk, Bagsvaerd, Denmark) in 17 cases, and by FVIII anti-inhibitor product (FEIBA, Baxter Corp, Toronto, Canada) in the remaining three procedures. A total of 51 patients from nine centers worldwide were included. The results of the procedures were characterized as good (82 procedures), fair (15), or poor (11). Postoperative bleeding complications requiring further surgical intervention occurred in three (15%) of the 20 major orthopedic procedures; all three procedures used rFVIIa as a hemostatic agent. Despite these complications, however, our study has shown that rFVIIa allows hemophilic patients with high inhibitor titers to undergo elective orthopedic surgery (EOS) with a greater expectation of success, leading to an improved quality of life. Thorough analysis of each case as part of a multidisciplinary team will help to identify further inhibitor patients in whom EOS can be performed both safely and effectively.