Elective total knee arthroplasty in haemophilic patients

Summary

Total knee arthroplasty (TKA) provides significant pain relief and better function in patients with end-stage haemophilic knee arthropathy. Peri- and postoperative care tends to be more complex than in non-haemophilic patients undergoing TKA and requires a multidisciplinary team approach. Aim: The implementation of standardized clinical pathways in non-haemophilic patients undergoing TKA has been shown to increase quality of care and to reduce postoperative complication rates. Consequently, the use of clinical pathways in haemophilic patients undergoing TKA may be beneficial to this particular subpopulation of patients. Methods: A clinical pathway for TKA for haemophilic patients was designed in a consensus process involving all participating departments. Results: We propose a specifically adjusted clinical pathway for TKA for haemophilic patients to show that standardization of elective orthopaedic surgery in haemophilia is feasible. Conclusion: The authors emphasize that there are limitations on categorizing haemophilic patients and stress that individual interdisciplinary treatment should take precedence over a standardized approach.

Zusammenfassung

Der künstliche Kniegelenksersatz bei Patienten mit endgradiger hämophiler Arthropathie reduziert zuverlässig den Gelenkschmerz und führt zur Verbesserung der Kniefunktion. Die periund postoperative Behandlung hämophiler Patienten ist jedoch komplexer als bei nicht-hämophilen Patienten und erfordert einen multidisziplinären Therapieansatz. Ziel: Die Einführung standardisierter klinischer Behandlungspfade in der Knieendoprothetik hat bei nichthämophilen Patienten zur Verbesserung der Versorgungsqualität und Reduktion postoperativer Komplikationen geführt. Die Implementierung eines Behandlungspfades in der Knieendoprothetik bei Patienten mit Hämophilie könnte daher ebenfalls vorteilhaft sein. Methoden: Unter Mitwirkung der beteiligten Fachdisziplinen wurde ein klinischer Behandlungspfad für die Knieendoprothetik bei Patienten mit Hämophilie entwickelt. Ergebnis: Der an die speziellen Bedürfnisse von hämophilen Patienten angepasste Behandlungspfad zeigt, dass eine Standardisierung in der Knieendoprothetik bei diesem Patienten möglich ist. Schlussfolgerung: Obwohl die Standardisierung der Knieendoprothetik bei Patienten mit Hämophilie prinzipiell sinnvoll ist, sollte die individuelle Zuwendung nicht zugunsten starrer Behandlungsschemata aufgegeben werden.

Keywords

Clinical pathway - total knee arthroplasty - haemophilia

Schlüsselwörter

Klinischer Behandlungspfad - Knieendoprothetik - Hämophilie

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