Danielson H, Ylinen P, Lassila R, Ristolainen L, Lohikoski J, Kautiainen H, Yrjönen T. Long-term functional and quality-of-life outcomes after knee replacement in patients with inherited bleeding disorders: A 15-year follow-up study. World J Orthop 2026; 17(8): 123952 [DOI: 10.5312/wjo.123952]
Corresponding Author of This Article
Heidi Danielson, MD, Research Institute Orton, Joint Replacement Orton Hospital, Tenholantie 10, Helsinki 00280, Uusimaa, Finland. heidi.danielson@icloud.com
Research Domain of This Article
Orthopedics
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research-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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
Abstract
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.
Citation: Danielson H, Ylinen P, Lassila R, Ristolainen L, Lohikoski J, Kautiainen H, Yrjönen T. Long-term functional and quality-of-life outcomes after knee replacement in patients with inherited bleeding disorders: A 15-year follow-up study. World J Orthop 2026; 17(8): 123952
Despite the advancement in medical therapy, haemophilic arthropathy or osteoarthritis (OA) still causes significant functional impairment in patients with inherited bleeding disorders (BD). Repetitive bleeds destroy joints (so-called target joints), thus leading to secondary OA. With the help of novel drugs and more efficacious dosing, as well as prophylactic coagulation factor therapy initiated in childhood, musculoskeletal complications can be significantly reduced; however, the treatment is expensive, and the worldwide availability of lifelong treatment remains limited.
Knee replacement is the gold standard for treating severe primary OA of the knee, with proven functional improvement in health-related quality of life (HRQoL)[1,2]. Good results have been demonstrated after total knee replacements (TKRs) in haemophilia patients as well, although the rarity of the condition and its variable clinical expressions complicate assessments[3-6]. Surgical treatment for haemophilia patients is significantly more expensive than conventional surgery: The costs of TKR in haemophilia patients are predominantly driven by perioperative coagulation factor replacement, often accounting for almost 90% of the total hospitalisation costs[7-10]. TKR in haemophilia patients is also associated with an increased risk of infection and aseptic loosening of the components, thus resulting in shorter long-term component survival[11-14]. Furthermore, haemophilic OA is often associated with bone cysts or bone deficits-including osteoporosis, joint deformation, and soft tissue stiffness or scar tissue-which further complicate the procedure[15,16]. This pathology reflects the hemostasis defect of the patients despite prophylactic therapy, which leads to intermittent dips in the coagulation factor [coagulation factor VIII, FVIII, FIX, or von Willebrand factor (VWF)].
It is possible that the patients with severe coagulation defects carry impaired wound healing based on animal work, but the proof in humans remains unclear[17-19]. Moreover, there is limited knowledge on the long-term functional outcomes of patients with inherited BDs after TKR, particularly after reoperations. We analysed the long-term results of knee replacements performed on BD patients at a national reference centre for the orthopaedic and haematological management of these patients; we compared these results with those of a registry-based age- and gender-matched group of primary knee OA patients and evaluated the HRQoL outcomes of BD patients against the general Finnish population.
MATERIALS AND METHODS
In our retrospective study, 90 knee replacements were performed in 53 patients with inherited BDs at Orton Orthopaedic Hospital, Helsinki, Finland (hereafter referred to as Orton), between 1984 and 2011 (Table 1)-a period of 27 years. Data were collected for all consecutive patients. Among these patients, 38 had haemophilia A, 7 had haemophilia B, and 8 had mostly type 3 severe von Willebrand disease (VWD). The surgical procedures required individualised replacement therapy, overseen by experienced haematologists in cooperation with the management team. Seventy-five (83%) knee replacements were performed with a non-constrained model (cruciate-retaining or posterior-stabilised); in 12 cases (13%), constrained or hinged models were used due to severe knee deformity, bone deficit, and/or knee stiffness. In addition, three medial hemiarthroplasties (unicompartmental knee replacement, 3%) were performed in cases of medial arthrosis. The medial parapatellar approach was employed in the TKRs, while medial mini-invasive approaches were applied in hemiarthroplasties.
Table 1 Baseline characteristics of 90 arthroplasties operated on patients with inherited bleeding disorder, n (%).
Cefuroxime was used as the antibiotic prophylaxis; the only exception was in the case of penicillin allergy, which is when clindamycin was used. The patients were not administered with pharmaceutical thromboprophylaxis, but compression stockings were routinely used postoperatively during their hospital stay.
General principles of therapy with coagulation factor replacement
Prior to surgery, the haematologist devised specific replacement therapy tailored to each patient’s bleeding phenotype and laboratory coagulation profile, considering their known response to the specific coagulation factor replacement. In a majority of patients with haemophilia A, plasma-derived (pd) FVIII concentrate (Amofil®, Sanquin Plasma Products, B.V. Amsterdam, NL) was predominantly used as replacement therapy, particularly since the study period began as early as 1984. In cases of haemophilia B, recombinant FIX concentrate (Benefix®, Pfizer Europe, Brussels, Belgium) was administered most often. Bolus dosing was used for both haemophilia A and B. In instances where specific coagulation products were not available in the earliest years, pd cryoprecipitate (Kryo or Kryo-AHG, Red Cross Blood Transfusion Service) was employed as replacement therapy in seven cases (8%). For five cases that involved inhibitor-positive haemophilia A patients, pd-activated prothrombin complex concentrate (Feiba, Baxalta Innovations GmbH, Austria, currently Takeda, Japan) and/or recombinant activated factor VII, rVFIIa (NovoSeven, Novo Nordisk Health Care AG, Switzerland) were used. Patients with VWD were managed with pd VWF (Haemate®, CSL Behring, Marburg, Germany) (Table 1).
The laboratory testing scheme was performed at two accredited centres: The coagulation laboratory of Red Cross Finland Blood Transfusion Service and the Helsinki University Hospital HUSLAB. The coagulation assessments of FVIII and FIX activity were conducted using one-stage clotting assays, while VWF antigen and ristocetin cofactor were assessed alongside FVIII. Blood samples (citrated plasma) for coagulation markers were collected twice on the first postoperative days and daily toward the end of the hospital stay.
Coagulation factor replacement therapy was typically performed twice or thrice on the day of the surgery and twice on the second to fourth postoperative days, depending on the extent of the surgery and the obtained coagulation factor levels. Subsequently, the therapy was administered daily, usually for 10-14 days, before switching to regular prophylactic use. In inhibitor-positive patients, the factor replacement therapy was individually tailored.
The target coagulation factor levels were perioperatively within a range of 80 IU/dL-100 IU/dL, corresponding to normal coagulation values, and were gradually tapered down to 50 IU/dL during days three to five when haemostasis was deemed good. The mobilisation of the patient occurred shortly after the administration of factor replacement therapy to ensure optimal support for haemostasis. Further, the haematocrit levels were maintained at or above 30% for the same purpose, along with a restrictive policy of red blood cell administration. The factor replacement therapy was individually tailored, with enhanced prophylactic regimen for two to three weeks after discharge and specifically adjusted for the rehabilitation period. The patients who had been on on-demand therapy continued temporal prophylaxis or switched from on-demand to the prophylactic strategy based on the clinical need. Complete blood cell count, prothrombin time, and activated partial thromboplastin time coagulation screening were routinely conducted three to five times during hospitalisation and on demand, if necessary, based on the baseline values and with factor-level (FVIII, FIX, VWF) monitoring.
Follow-up
Questionnaires for knee scores were routinely completed for all knee replacement patients before surgery, at two to three months post-surgery audits, as well as at all subsequent clinical controls. In our institution, the Hungerford knee score (-25-100 points, with 100 being the best) based on Hungerford and Kenna’s study[20] has been routinely used for pre- and postoperative evaluation. In this study, the explanations for the different options for pain were condensed compared with the original Hungerford score; for flexion contracture, we included an option of 0 degrees (‘goes straight’) (Supplementary Table 1). In addition to this score, we included clinical information on walking distance (Table 2).
Table 2 Baseline characteristics in walking ability, Hungerford total score, and Hungerford sub-items, n (%).
HRQoL in BD patients and in the general population
For this study, BD patients were also invited for another audit, on average, 15 years later, where-in addition to clinical examination and X-ray imaging-they completed the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) questionnaire regarding their HRQoL. We compared these SF-36 dimensions of BD patients after knee replacement with those of the general Finnish population (age- and gender-matched group)[21].
Orton hospital registry-based primary OA patients
We included TKR patients with primary OA from Orton registry data[22] with Hungerford scores before the operation and postoperatively at least at one and five years (to ensure regular follow-up at Orton). These data were calendar- and individual matched with the present series of BD patients for age and gender, thus resulting in 418 patients with 502 TKRs in the group (matching ratio 5). For the clinical evaluation of the knee, we used the same Hungerford structured score with a 100-point rating system as that for BD patients. Walking distance was supplemented as one item of the physical function measurement (0 = inability to walk, 100 = no restrictions).
The study was conducted according to STROBE guidelines[23] and funded by Orton research grants from the Ministry of Social Affairs and Health, Finland (A2500/422).
Statistical analysis
Summary statistics are presented as mean ± SD, medians with interquartile ranges, and n (%), as appropriate. Repeated measures of the total Hungerford knee score and walking ability score were compared between the BD group and the age-, sex-, and calendar year-matched OA group using mixed-effects models with an unstructured covariance structure. In addition, degrees of freedom were calculated using the Kenward-Roger method. Fixed effects included group, time, and the group × time interaction. The models accounted for within-practice clustering and within-patient correlation. Repeated measurements were collected at baseline and at two, four, six, eight, and ten years. Moreover, mixed-effects models permitted the analysis of unbalanced datasets without imputation; therefore, all available data from the entire analysis set were included.
Cumulative implant survival was estimated using the Kaplan-Meier method, and survival distributions were compared between the BD and OA groups using a permutation-type log-rank test. Associations that involved clustered or recurrent event data were analyzed using random-effects models (frailty models), which account for the correlation between observations within clusters or individuals. All statistical analyses were performed using Stata 18.0 (StataCorp LP, College Station, TX, United States).
RESULTS
The mean follow-up time for the BD patients was 15 years (range 0.5-36.5 years). Among the 53 patients, 17 (32%) underwent simultaneous bilateral procedures. At the time of the operation, the mean age of the patients was 46 years (SD = 11), with a median hospital stay of 15 days (range 12-18 days). The baseline characteristics of the patients are presented in Table 1.
During the follow-up period, 24 primary revision surgeries (27%) were performed. Among these, six revisions (7%) were performed due to bacterial infection (range 1.1-12 years after surgery, of which 1 (1%) revision procedure was performed 1.1 years after the primary surgery). In 14 cases (16%, range 0.7-18 years, of which 1 (1%) revision was performed 0.7 years after the primary surgery), the reason for the revision surgery was loosening of the components or other mechanical issues. The remaining four revisions (4%) were conducted due to the wearing of the polyethylene plate, thus necessitating its replacement along with the possible evacuation of granulomas. Revision surgery for any reason was defined as the endpoint in survival estimation. The Kaplan-Meier implant survival rate among BD patients was 94% [(95% confidence interval (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 (Figure 1). No significant difference in revision rates was observed between the surgeries performed before and after the year 2000.
Figure 1 Kaplan-Meier analysis of implant survival.
A: Kaplan-Meier analysis of implant survival of all 90 knee replacements in bleeding disorder patients. The gray area shows 95% confidence limits. No at risk: Number at risk; B: Implant survival according to subgroups of patients: HA: Hemophilia A; HB: Hemophilia B; VWD: Von Willebrand disease.
Hungerford score and Orton registry-based primary OA
According to the Hungerford score, BD patients demonstrated a significant improvement in total functional capacity, with a mean increase of 23.9 points (95%CI: 16.4-31.4, P < 0.001) during the first 2 years, a level that was sustained over the 10-year follow-up period. Similarly, the early change in functional score remained consistent in both study groups (OA patients, 23.4 points, 95%CI: 20.8-26.1, P < 0.001), without any statistical differences observed between the two groups (Figure 2A). Similar improvement curves were observed in walking ability (Figure 2B).
Figure 2 Functional outcomes following knee replacement.
A: Total Hungerford knee score between inherited bleeding disorder (BD) and osteoarthritis (OA) patients; B: Comparison of walking ability score between BD and OA patients. BD: Bleeding disorder; OA: Osteoarthritis.
HRQoL and comparison to the general population
The SF-36 dimensions collected (39/53 BD patients) during the mean 13-year clinical audit revealed lower scores than those for the age- and gender-matched general population, particularly in general health, pain, and physical roles. However, scores for vitality, social functioning, and emotional well-being and role were found to be similar (Figure 3).
Figure 3 Health-related quality of life according to the Medical Outcomes Study 36-Item Short Form Health Survey-dimensions health survey in 39 bleeding disorder patients.
Age- and gender-matched healthy controls from the study by Aalto et al[21] are shown by the dotted line. Whiskers show 95% confidence intervals.
DISCUSSION
The surgical treatment of BD patients involves more risks than the primary arthrosis population[4,13,24-28]. However, over the last decade, joint replacement surgery outcomes in haemophilia patients have undergone marked improvement[8,29-34]. This is also due to the multidisciplinary care model, which includes specialised nurses and physiotherapists in addition to doctors and laboratories monitoring the coagulation factor levels[35-38]. The present study is among the few to examine the long-term functional outcomes of BD patients, comparing them to primary OA patients and the general population[9,39].
The long-term Kaplan–Meier implant survival rates in BD patients were lower in the present study than those reported in patients with primary OA[40]. These results are in line with previous studies[4,12,41]. This emphasises the critical role of maintaining haemostatic potential during the recovery phase, particularly in supporting physiotherapy during healing. Severe haemostatic defects resulting in bleeds (both symptomatic and asymptomatic) are associated with impaired tissue healing[17-19]. Despite the enhanced targets for coagulation factor replacements, intermittent coagulation factor bolus dosing still leads to peaks and non-optimal troughs. Novel therapies with longer half-lives and non-factor therapies, such as emicizumab, are likely to bring benefits for the healing process. Although emicizumab is presently only available for haemophilia A, case studies suggest it may also benefit severe VWD; however, this is an area of ongoing research. Moreover, other non-factor therapies or rebalancing agents to improve haemostasis are available[42].
In our study, some patients with BD were followed regularly in the orthopaedic unit for more than 35 years. Although longer-term follow-up data were available, the graphical presentation comparing knee scores were limited to the first 10 postoperative years because the number of patients with complete follow-up declined over time, reducing the reliability of the estimates. Nevertheless, the pattern observed during the first 10 years remained consistent throughout the extended follow-up. Since joint replacement surgery for haemophilia patients in Finland was centralised at Orton during that time, the patients who required reoperation or those facing other issues likely remained in follow-up. Despite our potential emphasis on patients with complications, long-term improvement in the knee score was sustained. However, data limitations restrict broader conclusions, as does the evolving medical treatment landscape and changing implant models over the extended 40- year follow-up period.
During the last decade, new and more efficient innovations have been made in medical treatment for haemophilia, which may facilitate joint replacement surgery in the future[43,44]. Nowadays, the effective continued prophylactic medication available in developed countries is initiated early in childhood as primary prophylaxis and will likely prevent the development of severe secondary arthrosis. However, an increasing number of knee replacements already performed in haemophilia patients will require revision surgery in the future. Notably, little is known about survival and HRQoL after revision joint replacement in haemophilia patients. Kotela et al[45] reported good results in patients with BD after revision knee replacement due to aseptic loosening, but they reported impaired results after revision surgery for infection. In line with our results, a promising outlook exists for BD patients who require revision surgeries, provided the risk of bacterial infection is minimised in the future. To achieve the best outcomes, close cooperation with the haematologist, as well as a multidisciplinary team, will always be necessary[6,46,47] to avoid bleeding complications and ensure safe haemostatic protection during rehabilitation, the postoperative period, and even beyond.
When evaluating the results of joint replacement surgery in BD patients, the improvements in HRQoL may be more significant than what the functional results or implant survival alone suggest[5]. This was evident in our study, where HRQoL comparisons revealed more positive average performance than the functional score and implant survival curve alone among BD patients after joint replacement. A comparison of the SF-36 score yielded remarkable results. The BD patients had similar scores as the general population group in vitality, social functioning, and emotional well-being and role. This is the most encouraging observation, considering how BD also often affects other joints and muscle strength and broadly weakens the patients’ physical ability and performance, as the prophylactic therapy still has its limitations and significant burden.
CONCLUSION
In our study, BD patients demonstrated a significant long-lasting improvement in total functional capacity after knee replacement. In addition, patients with BD achieved functional improvements comparable to OA patients despite the lower implant survival rate. Despite the increased perioperative complexity and risk of complications, total knee arthroplasty remains a highly effective treatment for end-stage haemophilic arthropathy and should be considered when conservative treatment no longer provides adequate symptom control. Further studies, particularly on revision joint replacements and the quality of life of haemophilia patients, are needed, especially in the current era of drug development for haemophilia and VWD.
Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement. A meta-analysis.JAMA. 1994;271:1349-1357.
[PubMed] [DOI] [Full Text]
Rodriguez-Merchan EC, Mosconi M, De la Corte-Rodriguez H, Jannelli E, Pasta G. Total Knee Arthroplasty in People with Hemophilia: Higher Incidence of Periprosthetic Joint Infection and 1-Year Revision/Re-Operation than the General Population and Lower Prosthetic Survival When Early Postoperative Bleeding Complications Occurred: Current Literature Review.J Clin Med. 2024;13:2447.
[RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)][Cited by in RCA: 6][Reference Citation Analysis (0)]
Stan G, Orban H, Deculescu R, Roman M, Gheorghiu N. Surgical Outcomes, Complications, and Cost-Effectiveness of Total Knee Arthroplasty in Hemophilic Versus Non-Hemophilic Patients: A Comparative Study.Surgeries. 2025;6:101.
[PubMed] [DOI] [Full Text]
Ishihara J, Ishihara A, Starke RD, Peghaire CR, Smith KE, McKinnon TAJ, Tabata Y, Sasaki K, White MJV, Fukunaga K, Laffan MA, Lutolf MP, Randi AM, Hubbell JA. The heparin binding domain of von Willebrand factor binds to growth factors and promotes angiogenesis in wound healing.Blood. 2019;133:2559-2569.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 53][Cited by in RCA: 108][Article Influence: 15.4][Reference Citation Analysis (1)]
Hungerford DS, Kenna RV. Preliminary experience with a total knee prosthesis with porous coating used without cement.Clin Orthop Relat Res. 1983;95-107.
[PubMed] [DOI]
Aalto AM, Aro A, Teperi J.
[RAND-36 as a measure of health-related quality of life. Reliability, construct validity and reference values in the Finnish general population], in Finnish. Research report. National Research and Development Center for Welfare and Health, Research Reports 101. Helsinki: STAKES, 1999; 1999.
[PubMed] [DOI]
Pasta G, Vanelli R, Jannelli E, Castelli A, Mosconi M, Preti PS, Ambaglio C, Benazzo F. Primary total knee replacement in hemophiliacs: experience of a single institution over fourteen years of surgical procedures.J Biol Regul Homeost Agents. 2018;32:145-150.
[PubMed] [DOI]
Challoumas D, Munn D, Jeyakumar G, Bagot C, Rodgers R, Kearns R, Jones B. Outcomes of total hip and knee arthroplasty in patients with haemophilia: A meta-analysis of comparative studies and clinical practice recommendations.Haemophilia. 2024;30:180-194.
[RCA] [PubMed] [DOI] [Full Text][Cited by in RCA: 8][Reference Citation Analysis (0)]
Corresponding Author's Membership in Professional Societies: Chairperson of the Board, Finnish Arthroplasty Society (SAPLY); Board Member, Finnish Orthopaedic Association.
Specialty type: Orthopedics
Country of origin: Finland
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P-Reviewer: Changulani M, Consultant, FRCS (Ed), United Kingdom; Chen TX, PhD, China S-Editor: Qu XL L-Editor: A P-Editor: Wang WB
