Outcomes of Hip and Knee replacement Surgeries in Hemophilia Patients with HIV and Hep C

A new study out of Shanghai reports encouraging results after total hip or knee replacement in hemophilia patients who are infected with both HIV and hepatitis C virus (HCV). The research was published earlier this month in the journal BMC Musculoskeletal Disorders.

People with hemophilia commonly have severe joint damage by adulthood due to repeated bleeding episodes. Despite treatment advancements, patients with hemophilia are still at risk for developing chronic joint problems.

Total joint replacement (arthroplasty) can help relieve pain, restore function, and improve quality of life for many individuals. However, joint replacement surgery poses unique risks and challenges for patients with hemophilia and co-infection with HIV or the hepatitis C virus (HCV).

Past research has shown that HIV-positive patients with hemophilia have a higher likelihood of postoperative infection and less favorable outcomes after undergoing major elective procedures. Expert opinion is mixed opinions about whether the benefits of joint replacement outweigh the potential disadvantages in people with hemophilia and HIV. As surgical techniques and treatments become more advanced, the demand for orthopedic surgeries in this patient population has increased. An updated assessment of the effectiveness of arthroplasty in this group was needed.

To better understand the current role of total joint replacement in people with hemophilia and coinfection with HIV and HCV, a team of Chinese researchers, led by Zhengming Wang of Shanghai University of Traditional Chinese Medicine, analyzed the outcomes of hip or knee replacement surgery in such patients.

The researchers evaluated patients with hemophilia and HIV and HCV coinfection who underwent total hip or knee replacement surgery between January 2015 and June 2020. The patients were followed for at least 24 months and postoperative indicators were assessed. The study included patients with CD-4 T cells counts greater than 200 per cubic millimeter of blood and undetectable HIV load, and end-stage hip or knee arthritis. The study excluded individuals with previous hip or knee surgery, active infection, and inability to tolerate arthroplasty. Patients with poorly controlled HIV or other infection had their hip or knee surgery delayed until they met the criteria. Complications and satisfaction were analyzed to assess the risks and benefits of the procedure.

The study included 14 patients who underwent hip and knee arthroplasties. The average follow-up time was 53 months. The results showed statistically significant improvements in pain reduction and range of motion. The clinical outcome scores, including the Knee Society Score and Harris Hip Score, also significantly improved after surgery. Complications occurred in 19% of the arthroplasties performed, with the main complication being poor healing of incisions. However, no infections or deep vein thrombosis were reported. Overall, the majority of patients felt satisfied with their experience.

In their paper, the authors concluded that total hip or knee replacement “is a worthwhile procedure and can be performed by an experienced and collaborative multidisciplinary team in a tertiary center with a good hemophilia care system.”