Immediate and Long-Term Outcomes Following Orthopedic Procedures in Patients with Hemophilia: A Three-Decade Retrospective Review
Bibliographic record
Abstract
Introduction: Patients with hemophilia are at risk for developing hemophilic arthropathy and may require orthopedic interventions at a young age. It is unclear whether the advent of routine prophylaxis and comprehensive care have reduced the rates of orthopedic procedures in the past several decades, and whether improved supportive care have reduced perioperative complications. Aim: In this study, we aim to evaluate the overall trends of orthopedic procedures, surgical outcomes and healthcare utilization in patients with hemophilia who underwent orthopedic procedure in the past three decades. Methods: In this single-centre retrospective cohort study, adult patients with all severities of hemophilia who underwent at least one orthopedic procedure from January 1990-August 2018 at the University of Alberta Hospital were included. Demographic data, hemophilia history, details of orthopedic procedure, perioperative factor administration were collected. Temporal changes in the types of procedures, factor utilization, and outcomes were examined using descriptive analyses. Results: In the last 3 decades, 17 patients underwent 50 orthopedic procedures in our institution, including total knee arthroplasty (TKA) (n=18), TKA revision (n=8), total hip arthroplasty (n=5), ankle fusion (n=5), synovectomy (n=4), and others (n=10). Median age at the time of the procedure was 41 years (interquartile range IQR 31-48), and median BMI was 25 (IQR 22-39) (Table 1). Fourteen patients have hemophilia A and 3 have hemophilia B, including severe hemophilia in 13 (76%). Four patients (24%) have active inhibitors at the time of surgery. Ten (59%) patients had active hepatitis C infection at the time of surgery, whereas none had HIV infection. There is a reduction in the number of orthopedic surgeries performed over time (Table 2). There was a significant reduction in the length of stay from 1990-2000 to 2001-2018 (median 20 days vs 6 days, P <0.001). Overall perioperative coagulation factor concentrates were prescribed for a median of 10 days (IQR 7-20), whereas active inhibitor patients received bypassing agent coverage for a longer duration (median 17 days, IQR 10-21). There was a significant reduction in the perioperative factor VIII utilization over time (P=0.02), and a similar trend in factor IX utilization (Table 2). Tranexamic acid was used perioperatively in the majority (68%) of procedures for a median of 10 days. Pharmacologic thromboprophylaxis was prescribed in 15 (30%) procedures for a median of 8 days (IQR 7-13), intermittent pneumatic device was prescribed in 2, the remaining procedures had no documented thromboprophylaxis. Postoperative complications include major bleeding (n=2) and clinically relevant non-major bleeding (n=6), prosthetic joint infection (n=10), aseptic loosening requiring revision (n=2), poor wound healing complicated by skin necrosis (n=2), and deep vein thrombosis (n=1). The 10 infectious complications occurred in 6 patients, including early prosthetic joint infection <4 weeks in 6 cases, despite common use of prophylactic antibiotics in 92% of all cases. Pharmacological thromboprophylaxis was not associated with an increased risk of bleeding. There were no inhibitor development or arterial thromboses perioperatively. All complications occurred in surgeries performed prior to 2011. Conclusions: Over the past three decades, we observe a decline in the number of orthopedic procedures performed in patients with hemophilia, likely reflecting the impact of routine prophylaxis and changes in practice patterns. Orthopedic outcomes have improved over time, in conjunction with a reduction in healthcare utilization including shorter length of stay and reduced factor utilization. Disclosures Sun: Octapharma: Consultancy, Research Funding; Novo Nordisk: Consultancy.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".