Rehab improves knee replacement outcomes in hemophilia patients
10-year study in China found gains in function, movement, pain
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Rehabilitation improves knee function, movement, and pain after knee replacement in hemophilia patients.
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Hemophilia causes joint damage; total knee arthroplasty is for severe cases.
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Pre-rehabilitation and psychological support are crucial for recovery.
A structured rehabilitation program improved knee function, movement, and pain in people with hemophilia after total knee arthroplasty, a surgical procedure that replaces the knee joint, according to a 10-year study in China.
While improvements were seen across patients with varying levels of knee mobility before surgery, those who started with better knee mobility continued to show greater mobility after rehabilitation and at long-term follow-up.
The results support the “effectiveness of rehabilitation” in people with hemophilia after total knee arthroplasty, researchers wrote. They also highlighted the importance of preoperative evaluation, pre-rehabilitation and psychological support, early initiation of postoperative rehabilitation, close monitoring of clotting factor levels, and promoting recovery of nearby joints to optimize outcomes.
The study, “A retrospective study of rehabilitation for patients with hemophilia knee osteoarthritis after total knee arthroplasty: a 10 year cohort study,” was published in BMC Musculoskeletal Disorders.
Total knee replacement an option in severe joint bleeding cases
People with hemophilia, a genetic disorder that impairs the blood’s ability to clot properly, often experience repeated bleeding into their joints, particularly the knees. Over time, this causes inflammation, pain, stiffness, and progressive joint damage, a condition known as hemophilic arthropathy.
In severe cases, where joint bleeding can occur as often as 20 to 30 times per year, total knee arthroplasty is considered the best treatment option. Recovery, however, can be challenging.
“Rehabilitation is an important means to help hemophilic arthropathy patients recover joint function after total knee arthroplasty,” the researchers wrote.
In this study, a team of Chinese researchers retrospectively analyzed rehabilitation outcomes in 50 men with hemophilia who underwent total knee arthroplasty between 2011 and 2021. Surgery involved the left knee in 28 cases and the right knee in 22. All patients were followed for at least two years after surgery.
Knee function, range of motion, pain levels improved in all 3 groups
The mean age at the time of surgery was 37.96 years, and patients had been living with hemophilia for a mean of 28.64 years. Most (88%) had hemophilia A, while 12% had hemophilia B. A total of 13 patients had mild disease, 21 had moderate disease, and 16 had severe hemophilia.
Before surgery, patients were grouped based on their knee range of motion, which reflects how much the knee can bend and straighten. Fourteen patients had severely limited movement (0 to 45 degrees), 28 had moderate movement (45 to 90 degrees), and eight had relatively preserved movement (more than 90 degrees).
All patients followed the same rehabilitation approach. Before surgery, patients underwent joint and muscle assessments to guide rehabilitation planning, along with psychological counseling and pre-rehabilitation to prepare them for postoperative recovery and encourage active participation.
After surgery, rehabilitation exercises were carefully timed to begin 30 to 60 minutes after factor replacement therapy to reduce the risk of bleeding. At this time, levels of clotting factors — proteins that help blood clot and are deficient in people with hemophilia — reach their peak, the researchers noted. Sessions were performed once or twice daily under medical supervision.
During the first three days after surgery, rehabilitation focused on improving knee movement, muscle strength, walking ability, and function of nearby joints such as the hip and ankle, with weight-bearing introduced gradually. From days three to seven, patients progressed from active-assisted to active knee movement. Resistance training was added starting in the first week after surgery. If joint bleeding occurred at any time, rehabilitation was stopped immediately, and bleeding was treated appropriately.
After rehabilitation, knee function, range of motion, and pain levels significantly improved in all three groups, regardless of preoperative knee mobility.
The effectiveness of rehabilitation in hemophilic knee arthropathy patients after [total knee arthroplasty] is evident.
However, significant differences in improvements were observed among groups. Patients with the highest knee range of motion before surgery continued to show greater mobility after rehabilitation and at long-term follow-up than those who started with poorer mobility.
In contrast, patients with the most severe joint stiffness before surgery had poorer knee function than those with better presurgical mobility both after rehabilitation and at long-term follow-up. They also reported higher pain levels at long-term follow-up.
Complications occurred in eight patients (16%). One patient required additional surgery after sustaining a fracture around the artificial joint following a fall one year after surgery. All other issues were resolved with appropriate care. No joint infections were reported.
Nearly all patients reported satisfaction with their surgical and rehabilitation outcomes. The one patient who experienced the fracture reported disappointment.
“The effectiveness of rehabilitation in hemophilic knee arthropathy patients after [total knee arthroplasty] is evident,” the researchers concluded, adding that patients with higher preoperative range of motion “tend to have better postoperative mobility and knee joint function.”
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