[Total hip and knee arthroplasties in hemophilia. Apropos of 27 cases].

Thirteen total hip and 14 total knee prostheses were performed in 21 haemophilic patients. Nineteen had severe factor deficiency. Their average age was 43 years. Pain was the only indication for hip prostheses. All the hip arthropathies were of Arnold stage IV or V. For the knees, the indication was permanent pain with patello-femoral involvement in nine cases. In other cases, stiffness and instability was the indication. Seven knees, one out of two, had a flexion deformity of more than 30 degrees and only in four knees, one in three, was the range of flexion greater than 90 degrees. The quadriceps was extremely atrophied in eight knees and was always fibrotic. The arthropathies were of stage IV in three cases and stage V in eleven cases. There was pre-operative valgus deformity, greater than 20 degrees in three cases. At the hip, all 13 total prostheses were cemented. The 11 patients had factor replacement for an average of 21 days. No inhibitor was present pre-operatively or developed after operation. Early complications were rare: two moderate hematomata of the hip and one haematoma of the homolateral psoas. The late complications were not unusual: two aseptic bipolar loosenings after eight and nine years. At long-term follow-up, with a mean of four years and one month, 77 per cent of the hips were painless and stable with a good range of movement. Eight per cent were painless and stable but had some limitation of flexion. Fifteen per cent were failures. At the knee, a Guepar I knee was inserted in four cases, a Total Condylar knee in eight cases and a Kali knee in two cases. All the patients had factor replacement for 24 days. No post-operative inhibitor developed. The early complications were three superficial skin necroses, four deep hematomata and one transient common peroneal nerve palsy. The late complications were one permanent dislocation of the patella and one bipolar septic loosening with septic pyaemia which needed an arthrodesis and required 79,290 International Units of factor VIII, 72 units of packed cells and 28 bottles of fresh plasma. After a mean follow-up of two years and five months, five knee prostheses had a very good results, four a fair result and five a bad result.