Joint reconstruction or replacement is a surgical procedure that helps people who suffer from chronic pain, which may interfere with their daily activities. During this surgical procedure, the damaged joint and bone are removed and replaced with plastic and metal components.
Joint damage is a common problem for many patients suffering from hemophilia, and many hemophilia patients require joint reconstructive surgery.
Performing surgery on individuals with hemophilia requires an experienced, multidisciplinary team of surgeons, hematologists, internists, pediatricians, nurses, physical therapists and social workers. The surgery should also be undertaken at an established hemophilia center like OHTC if possible to ensure that the relevant pre-operative planning and patient counseling taken care of.
At OHTC the pre-operative process is very rigorous and patients must be able to cooperate with thorough post-operative rehabilitation regimens that pay meticulous attention to infection-prevention.
During the pre-operative evaluation, patients are carefully screened for the presence of inhibitors (a patient’s own antibodies that inactivate the clotting factor). Two hours prior to surgery, the patient is infused with a dose of clotting factor calculated to attain 100% of normal levels, which is confirmed with a factor assay. The patient is then started on a continuous infusion of the clotting factor to maintain levels at greater than 60% throughout the surgical procedure. Immediate postoperative levels are rechecked.
Thereafter, levels are checked every one or two days. A 60% level is maintained by continuous infusion until the patient is discharged. Injections of factor at home are used to maintain 30% to 60% levels for at least two weeks postoperative. After that, if vigorous physical therapy is needed, for example following a total knee replacement (TKR), the patient is infused to a 30% level just prior to therapy.
Contrary to what might be expected, dependency on narcotic analgesics and impaired pain tolerance is uncommon within this patient population. However, when these conditions do exist, special attention and pre-operative planning is required to assure that patients have the ability to cooperate with the vigorous physical therapy regimen and meticulous care in the prevention of infection.
OHTC has found drug dependency to be a risk factor in late infection of prosthetic joints in hemophilia patients. These problems must be resolved before proceeding with reconstructive surgery.