Perioperative blood management and clinical outcomes in patients with hemophilia undergoing total joint arthroplasty: Our long-term results

Abstract

Objectives: This study aims to evaluate the efficacy and safety of a comprehensive, multidisciplinary perioperative blood management (PBM) protocol in patients with Hemophilia A undergoing total joint arthroplasty (TJA).

Patients and methods: Between December 2014 and November 2024, a total of 29 male patients (mean age: 33.38 ± 8.62 years; range, 20 to 55 years) with hemophilic arthropathy (HA), all diagnosed with Hemophilia A, who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were retrospectively analyzed. All patients received a standardized PBM protocol, including preoperative factor Ⅷ sensitivity testing, individualized factor replacement, restrictive fluid management, ultrasound-guided regional anesthesia, and tranexamic acid administration. Primary outcomes included total blood loss (TBL) and hemoglobin (Hb) drop. Secondary outcomes included operation time, length of hospital stay (LOS), and perioperative complications.

Results: All 29 procedures were successfully completed under our PBM protocol. For the entire cohort, the median TBL was 630.52 (range, 470.95 to 939.64) mL, and the mean Hb decrease on postoperative Day 5 was –41.83 ± 22.81 g/L. The median operative time was 122.0 (range, 91.0 to 182.5) min, and the median LOS was 23.0 (range, 19.0 to 31.0) days. Simultaneous double TJA showed higher TBL and transfusion rates than single TJA, but the outcomes remained within safe clinical limits. Furthermore, THA was associated with significantly shorter operation time (p = 0.008) and lower total FⅧ consumption (p = 0.036) compared to TKA, despite similar TBL (p = 0.860). No major complications, such as inhibitor development, hemorrhage or venous thromboembolism were observed.

Conclusion: A standardized, multidisciplinary PBM protocol ensures surgical safety in patients with end-stage HA. Despite the underlying hemorrhagic diathesis, optimized factor replacement and comprehensive anesthetic strategies can achieve surgical outcomes comparable to the general population. These findings support the broader clinical application of comprehensive PBM for high-risk hemophilic surgical cases.

* These authors contributed equally to this work.

Citation: Peng M, Li S, Wu X, Ma W, Li Y. Perioperative blood management and clinical outcomes in patients with hemophilia undergoing total joint arthroplasty: Our long-term results. Jt Dis Relat Surg 2026;37(3):649-657. doi: 10.52312/jdrs.2026.2794.

M.P., S.L.: Conceived and designed the study, performed data analysis, and wrote the original draft; X.W.X Was responsible for data collection and literature review; W.M.: Provided materials and supplementary analysis; Y.L., X.W.: Contributed to reference preparation; W.M., Y.L.: Provided critical intellectual input and revised the manuscript; Y.L.: Supervised the project. All authors have read and approved the final version of the manuscript.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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