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World J Orthop. Aug 18, 2026; 17(8): 123952
Published online Aug 18, 2026. doi: 10.5312/wjo.123952
Long-term functional and quality-of-life outcomes after knee replacement in patients with inherited bleeding disorders: A 15-year follow-up study
Heidi Danielson, Pekka Ylinen, Riitta Lassila, Leena Ristolainen, Jouni Lohikoski, Hannu Kautiainen, Timo Yrjönen
Heidi Danielson, Pekka Ylinen, Leena Ristolainen, Jouni Lohikoski, Timo Yrjönen, Research Institute Orton, Joint Replacement Orton Hospital, Helsinki 00280, Uusimaa, Finland
Heidi Danielson, Department of Orthopedic, Eira Hospital, Helsinki 00150, Uusimaa, Finland
Riitta Lassila, Research Program Unit in Systems Oncology, Helsinki University and Coagulation Disorders Unit, Department of Hematology and Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki 00029, Uusimaa, Finland
Hannu Kautiainen, Primary Health Care Unit, Kuopio University Hospital, Kuopio 70210, Pohjois-Savo, Finland
Hannu Kautiainen, Folkhälsan Research Center, Folkhälsan, Helsinki 00250, Uusimaa, Finland
Author contributions: Ylinen P, Yrjönen T, Lassila R, and Danielson H designed the study; Danielson H performed the clinical follow-up assessments; Danielson H, Ristolainen L, and Lohikoski J collected the data; Kautiainen H performed the statistical analyses; Danielson H drafted the manuscript; and Lassila R, Ylinen P, and Yrjönen T critically revised the manuscript for important intellectual content. All authors contributed to the interpretation of the data and have read and approved the final manuscript.
AI contribution statement: During manuscript preparation, AI-assisted tools were used for editorial support and minor language refinement. No AI tool was used to independently generate scientific content, analyse data, interpret findings, design the study, conduct the literature review, or draw conclusions. The authors are solely responsible for all scientific concepts, data analyses, interpretation of results, and final manuscript revisions. No AI-generated figures, images, or graphical content are included in this manuscript.
Supported by Orton Research Grants, Ministry of Social Affairs and Health, Finland, No. A2500/422.
Institutional review board statement: This study has been approved by the Ethical Committee of Helsinki University Hospital (393/13/03/02/2010).
Informed consent statement: Written informed consent was obtained from participants who took part in the voluntary follow-up examinations conducted as part of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. The data are not publicly available because the study includes a small cohort of patients with inherited bleeding disorders, and public release of the data could increase the risk of participant identification despite de-identification measures.
Corresponding author: Heidi Danielson, MD, Research Institute Orton, Joint Replacement Orton Hospital, Tenholantie 10, Helsinki 00280, Uusimaa, Finland.
heidi.danielson@icloud.com
Received: June 2, 2026
Revised: June 30, 2026
Accepted: August 10, 2026
Published online: August 18, 2026
Processing time: 73 Days and 18.6 Hours
BACKGROUND
Haemophilia and severe forms of von Willebrand disease are rare inherited bleeding disorders (BDs) that can cause secondary osteoarthritis (OA) with significant functional impairment. In primary knee OA, joint replacement surgery has been shown to be rather effective and beneficial. However, concerns regarding secondary OA related to BDs include a more severe initial condition, soft tissue imbalance, and increased risk of infection. The costs of joint replacement surgery in BD patients are also significantly higher compared to those of the surgery in primary OA patients.
AIM
To evaluate the long-term outcomes of BD patients undergoing knee replacement, considering quality of life and functional outcomes.
METHODS
This retrospective cohort study included all consecutive knee arthroplasties performed in patients with BDs at Orton Orthopaedic Hospital, Finland, from 1984 to 2011-comprising 90 knee arthroplasties in 53 patients. The long-term postoperative functional outcomes, assessed using the Hungerford score, were compared with those of calendar-, age-, and gender-matched patients who underwent knee arthroplasty for primary OA, while health-related quality of life, Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was compared with that of the age- and gender-matched general Finnish population.
RESULTS
BD patients significantly improved in terms of total functional capacity, with an increase of 23.9 points [95% confidence interval (CI): 16.4-31.4] in the Hungerford score during the first two years. This improvement was maintained throughout the 10-year follow-up, with no significant difference in functional outcomes compared with primary arthroplasty patients. Similar improvement was observed in their walking ability. SF-36 dimensions revealed lower scores among BD patients than the general Finnish population for pain, health, and physical roles; however, importantly, BD patients had similar scores in vitality, social functioning, and emotional well-being as the general Finnish population. The Kaplan-Meier rates for BD patients were 94.0% (95%CI: 86.3-97.5) at 5 years, 79.8% (95%CI: 68.6-87.4) at 10 years, and 56.6% (95%CI: 40.4-69.9) at 20 years.
CONCLUSION
BD patients demonstrated a significant improvement in their total functional capacity. The functional improvements were comparable to OA patients despite lower implant survival.
Core Tip: Long-term outcome data after total knee replacement (TKR) in patients with inherited bleeding disorders (BDs) are scarce. This study provides very long-term follow-up data, with a mean follow-up duration of 15 years. Patients achieved sustained improvements in functional capacity and favorable quality-of-life outcomes, with results comparable to those of patients undergoing knee replacement for primary osteoarthritis. These findings support TKR as an effective treatment for advanced arthropathy associated with inherited BDs.
