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

Table 3

Previous reported amputation cases.

Case number	Hemophilia type and main concomitant diseases	Musculoskeletal involvement	Surgical procedures	Reason for amputation
1 [11]	Moderate HA	Pathological fracture with HPT on right femoral shaft	Closed reduction and external fixation of right thigh; HPT excision with open reduction and internal fixation of tight thigh; high-thigh amputation	Pin infection, internal fixation failure, HPT recurrence
2 [11]	Severe HA	Pathological fracture with HPT on left femoral shaft	High-thigh amputation	Fracture and enlargement of HPT
3 [11]	Moderate HB	Pathological fracture with HPT on left femoral shaft; HPT on right femoral shaft with secondary pathological fracture on tight femoral shaft	Disarticulation of left hip; high-thigh amputation of right side	Fracture and enlargement of HPT
4 [9]	Severe HA	HPT, fracture of right femur	External fixation for femur fracture; Removal of external fixator, HPT excision and open reduction with internal fixation; amputation of left thigh at last	Nail infection, internal fixation failure
5 [9]	Mild HA	HPT, cutaneous fistulas and infection on thigh	Amputation of right thigh	Infection
6 [9]	Mild HA	HPT, cutaneous fistulas and infection on knee	Amputation of right thigh	Infection
7 [9]	Moderate HA with inhibitor	HPT with cutaneous fistulas and infection on left thigh	Amputation of left thigh	Infection
8 [9]	Severe HB	HPT with cutaneous fistulas and infection on both thigh and left knee	Left thigh amputation; right HPT excision; right thigh amputation	Infection for left thigh, HPT recurrence with osteolysis for right thigh
9 [9]	Moderate HA	HPT, cutaneous fistulas and infection on thigh	Amputation of left thigh	Infection
10 [9]	Moderate HA, with inhibitor	HPT, cutaneous fistulas and infection on left calf	Amputation of left calf	Infection
11 [9]	Severe HA	Massive HPT on left thigh	Amputation of left thigh	Enlargement of HPT
12 [9]	Severe HA	Massive HPT on right thigh	Amputation of right thigh	Enlargement of HPT
13 [16]	Moderate HA	Huge HPT with osteolysis on right femur	Hematoma evacuation, debridement and hip hemiarthroplasty; right hip dislocation	Wound infection with ulcer, hip prosthesis dislocation
14 [16]	Mild HA	Primary benign bone giant cell tumor on right distal fibula	Intralesional cottage (2 times); aboveknee amputation	Severe hematoma and wound dehiscence
15 [17]	Severe HA	HPT with osteolysis on distal phalanx of left little finger	Left little finger amputation	Persistent infection and enlargement of HPT
16 [17]	Severe HA	HPT with osteolysis on middle phalanx of left little finger	Left little finger amputation	Persistent infection and enlargement of HPT
17 [18]	N/A	Massive HPT on knee	Intralesional excision of pseudotumor with bone cement spacer implantation; above-knee amputation	Pseudotumor recurrence after excision
18 [19]	Moderate HA	Pathological fracture, then recurrent HPT on left femur	Open reduction and intramedullary fixation and a revision surgery; left lower limb amputation	Recurrent pseudotumor and persistent swelling of left limb
19 [19]	Severe HA with low titre of inhibitor	HPT on right tibia and fibula	Right lower limb amputation	Pain and arterial ulcer
20 [20]	HA, AIDS, hepatitis B and C	Huge HPT on right femur	Right hip dislocation	Hematoma enlargement with spontaneous bleeding, heart and kidney failure
21 [21]	Severe HA with high titre of inhibitor, hepatitis C, diabetic mellitus	Huge HPT and secondary compartment syndrome on left distal limb	Supracondylar amputation of left limb	Severe compartment syndrome with phlegmon
22 [22]	Severe HA with high titre of inhibitor,	Hemophilia arthritis	Knee replacement of left side; revision of left knee; above-knee amputation of left knee	Uncontrolled infection after knee replacement
23 [23]	Severe HA	HPT with osteolysis on second metacarpal bone of right hand	Ray amputation of right index finger	Enlargement of HPT limited hand move
24 [24]	Severe HA	Multiple HPT with osteolysis on right femur, knee and tibia	Amputation of left lower limb	Enlargement of HPT and limitation of move
25 [25]	Severe HB with low titre of inhibitor	Multiple HPT with osteolysis of right proximal tibia and foot, with necrotic of left foot soft tissue	Transfemoral amputation of left lower limb	Enlargement of HPT with infection
26 [26]	Moderate HA with high titre of inhibitor	Pathological fracture followed by HPT on left tibia/fibula	Left knee disarticulation	Wound infection
27 [27]	Moderate HA	Hemophilia arthritis	Proximal tibial osteotomy of left side; Anterior and posterior fasciotomies; above-knee amputation	Deep venous thrombosis

HA, hemophilia A; HB, hemophilia B; HPT, hemophilic pseudotumor; N/A, not referred.