Research Article

Risk Factors for Amputation in the Surgical Treatment of Hemophilic Osteoarthropathy: A 20-Year Single-Center Report

Table 1

Patient characteristics, management, and outcome of amputation cases.

PatientType and severityInhibitorDuration until amputationDaily factor replacementInitial diagnosis of HOManagement before amputationDirect reason for amputationAmputation procedureOutcome

1A, severeYes, active (6.8 ⟶ 1.9 BU/ml)21 yearsRegular replacement as secondary prophylaxis (FVIII 20,000 IU per year)Hemophilic arthritis of both hip and kneeBilateral THAHemophilic pseudotumor with large bone defects (following periprosthetic fracture)Disarticulation of left hip, right TKALeft hip wound unhealing, received debridement three times. The wound healed after 6 months’ dressing, walking with crutches (3 years after amputation)
2A, severeNo17 yearsInadequate secondary prophylaxis. (irregular FVIII injection on demand)Pathological fracture of right femurBone traction of right femoral fracturePathological fracture, internal fixation failure, hemophilic pseudotumor with infectionAbove-knee amputation of right sideNo complication, walking with crutches (3 years)
3A, moderateNoSince childhood (26 years)Regular primary prophylaxis (FVIII approx. 5,000 IU per year)Hemophilic arthritis with chronic osteomyelitis on right kneeDebridement of right knee ulcerative woundsKnee stiffness with chronic osteomyelitisAbove-knee amputation of right sideNo complication, walking with crutches (1 year)
4A, moderateNoSince childhood (24 years)Regular primary prophylaxis (FVIII injection)Hemophilic pseudotumor of right thigh, with systematic infectionN/AHemophilic pseudotumor with systematic infectionHigh-thigh amputation of right sideTransferred to ICU for 3 days after the operation, no postoperative complication; died from epilepsy two years after amputation