Prosthesis survival situation and complications following total hip arthroplasty in hemophilic patients: a systematic review.

Background: Hemophilic arthropathy, resulting from recurrent joint bleeding in patients with hemophilia, often necessitates total hip arthroplasty (THA) to alleviate pain and improve joint function. However, the unique challenges posed by hemophilia, including coagulopathy and compromised bone health, result in increased risks of complications such as bleeding, infection, and prosthesis loosening.

Methods: A systematic search of PubMed, Cochrane Library, EMBASE, and Web of Science was conducted up to September 2024. Studies reporting prosthesis survival or complications in hemophilia patients undergoing THA were included. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results: Fourteen retrospective cohort studies, encompassing 190 THA cases, were included. A total of 190 THA cases were involved, of which 175 prostheses survived, with aseptic loosening (57%) being the leading cause of failure. Complications included bleeding (34.8%), infections (19.7%), and aseptic loosening (15.1%). Key risk factors included reduced bone mineral density, recurrent hemarthrosis, and immune dysfunction (HIV) due to clotting factor infusions. Strategies such as preoperative optimization of clotting factors and bone quality were highlighted as crucial for improving outcomes.

Conclusions: This paper confirms the findings of previous studies that THA is an effective treatment for advanced-stage haemophilic arthropathy, offering significant pain relief and improved function. However, its high rate of complications has to be reduced with a correct perioperative hemostasis and a good surgical technique. This type of surgery should only be performed in centers specialized in the treatment of haemophilia by a team of surgeons expert in the implantation of hip prostheses.