Short-term outcome of total knee replacement in a patient with hemophilia: A case report and review of literature.

BACKGROUND: Hemophilia A is a rare inherited bleeding disorder caused by mutations in the factor VIII gene. This clotting factor plays an intrinsic role in the blood coagulation pathway. Patients with hemophilia may develop orthopedic manifestations such as hemarthrosis, but multiple malunion of fractures over the knee is rare and difficult to treat. CASE SUMMARY: We report a patient with hemophilia A who developed severe knee osteoarthritis along with fracture malunion and nonunion. Total knee replacement was performed using a custom-made modular hinged knee prosthesis (cemented) equipped with extended distal and proximal stems. At 3 years' follow-up, the patient exhibited excellent clinical function and remained satisfied with the surgical outcome. Surgical intervention was accompanied by rigorous coagulation factor replacement. CONCLUSION: This case highlights various unique scenarios specific to individuals with hemophilia and fracture deformity.

Different changes of microarchitectures of cortical and cancellous bones in sheep femoral head after long-term glucocorticoid interventions.

This study investigatedthe different effects of long-term glucocorticoid (GC) interventions on the microarchitectures of cortical and cancellous bones of the femoral head. Eighteen female skeletal mature sheep were randomly allocated into 3 groups, 6 each. Group 1 received prednisolone interventions (0.60 mg/kg/day, 5 times weekly) for 7 months. Group 2 received the same interventions as Group 1 and then further observed 3 months without interventions. Control Group was left nonintervention. After killing the animals, all femoral heads were scanned by micro-CT to determine their microstructural properties. In cancellous bone of femoral head, GC interventions led to significant decrease of bone volume fraction, trabecular thickness, trabecular separation, but increase of structure model index and bone surface density (p < 0.05). While in cortical bone, there were no differences between the Group 1 and in microstructural properties (p > 0.05) except greater trabecular thickness in the control group. In addition, three months after cessation of glucocorticoid interventions, most microstructural properties of cancellous bone were significant reversed, but not cortical thickness of femoral head. In contrast to cancellous bone, the microarchitectures of cortical bone were not changed obviously after long-term GC interventions.