Navigated implantation of total knee prostheses in haemophilic arthropathy

Introduction: In severely affected haemophilic patiens arthophaty is a common problem which can lead to considerable pain and functional deficit. Surgical management, including total joint arthroplasty, can be undertaken if conservative management fails. A search of the literature showed a number of studies describing the use of total knee arthroplasty (TKA) but virtually nothing has been written about the use of computer-assisted prosthetic surgery in patiens with coagulation problems. Due to the early-onset severe arthropathy, haemophiliacs undergo prostethic surgery at a younger age than the general population; therefor ensuring a longer duration of implantations is a major objective to be reached in this setting. As several prospective randomized studies could show, computer navigation in prosthetic surgery improve precision concerning geometry of axes, resection planes and implant alignment, by the determination of joint centres (actual axes), amount of bone resection, sizes of prostheses and check of ligament balance. Material and methods: At our departement, since January 2006, we implanted 4 TKA in 4 patients (age range 45-52 years) affected by severe Haemophilia B; the same surgeon used a single system (Orthopilot system) in all cases. The quality of implantation was studied on postoperative standardized long leg coronal and lateral x-rays. Results: Our results showed that CAS had greater consistency and accuracy in implant placement. Complications influencing the clinical outcome did not occur. In our experience, drawbacks of the navigation systems are the additional costs and the addicional operation time between 15 and 25 mins. However, one of the most important advantages of using this technique in patients affected by coagulation disease, according to the international literature, is the reduction of less blood after operation. Conclusions: A long-term follow-up of these and of a larger samples of patients is needed for testing cost/risk-benefit ratio of Orthopilot in prosthetic surgery of haemophiliacs. Therefore, navigated total knee arthroplasty in haemophilic arthropaty is not yet a standard procedure, but this technique could become an important surgical choice in management of severe secondary osteoarthritis in the future.