Total joint replacement in inhibitor-positive haemophilia: Long-term outcome analysis in fifteen patients

Table 1 Main surgical operations in patients (A and B) with the low historical inhibitor titre (< 5 BU/mL)

Patient and operations (model)	Haemophilia therapy	Primary haemostatic outcome	Surgical outcome
A
TKR (cruciate retaining)	Cryo (AHF-20) → pdFVIII	Good	Good
TKR (cruciate retaining)	pdFVIII	Good	Good
Ankle arthroplasty	pdfVIII	Good	Good
Ankle arthroplasty	pdFVIII	Good	Good
Knee revision arthroplasty (reconstructive)	rFVIII	Fair	Good
Knee revision arthroplasty (reconstructive)	rFVIII	Good	Good
B
Knee hemiarthroplasty (unicondylar)	pdFVIII	Good	Poor
Revision arthroplasty (cruciate retaining)	pdFVIII → rFVIIa	Fair	Good

In A, six operations and in B, two operations were performed. TKR: Total knee replacement; pdFVIII: Plasma-derived factor VIII; rFVIII: Recombinant FVIII.

Table 2 Main surgical operations in the patients (C-F) with the high historical inhibitor titre

Patient and operations (model)	Replacement therapy	Primary haemostatic outcome	Surgical outcome ROM/pain
C
TKR bilateral (hinge + posterior stabilised)	pdFVIII → aPCC	Poor	Fair
THR (uncemented)	rFVIII	Good	Good
D
TKR bilateral (reconstructive)	aPCC → rFVIIa	Fair	Fair
E
TKR (posterior stabilized)	aPCC → rFVIIa	Poor	Good
F
Glenohumeral hemiarthroplasty	rFVIII	Good	Good

ROM: Range of motion; TKR: Total knee replacement; THR: Total hip replacement; aPCC: Activated prothrombinase complex concentrate.

Table 3 Cost analysis of arthroplasties on inhibitor patients since 2005

Resp	Operation		Component	TOT eur	HT2 eur	HT (%)3	Product®	Hospital stay(d)
Low	Knee revision arthroplasty	Unilateral	Reconstructive	103200	75700	73	Kogenate Bayer	18
Low	Knee revision arthroplasty	Unilateral	Reconstructive	95400	66900	70	Kogenate Bayer	11
Low	Ankle arthroplasty	Unilateral	Primary ankle	47200	35600	75	Kogenate Bayer	10
Low	Ankle arthroplasty	Unilateral	Primary ankle	60200	48800	81	Kogenate Bayer	12
Low	Knee hemiarthroplasty	Unilateral	Unicondylar	51500	41600	81	Amofil	9
Low	Knee revision arthroplasty	Unilateral	Cruciate retaining	50200	36300	72	Amofil	8
High	Knee arthroplasty	Bilateral	Ps4 + hinge	350900	305500	87	Amofil	24
							FEIBA
High	Hip arthroplasty	Unilateral	Primary uncemented	43300	27800	64	ReFacto AF¹	8
High	Knee arthroplasty	Bilateral	Reconstructive	500400	445100	89	FEIBA	24
							NovoSeven
High	Knee arthroplasty	Unilateral	Ps4	409900	386100	94	FEIBA	15
							NovoSeven
High	Glenohumeral arthroplasty	Unilateral	Primary glenohumeral	49800	29300	59	ReFacto AF¹	9

¹Successful preoperative ITI;

²HT haemophilia therapy (costs of replacement therapy);

³Procentual costs of replacement therapy;

⁴Ps posterior stabilized; Resp: Inhibitor responder (low = historical inhibitor titre < 5 BU/mL, high = historical inhibitor titre > 6 BU/mL).