Использование модульной эндосистемы для протезирования тазобедренного сустава, бедренной кости и коленного сустава у больного с тяжелой формой гемофилии А:

Summary. The article presents a case of using a modular endosystem (mega prosthesis) that prosthetics the knee joint, femur and hip joint in a patient with severe hemophilia A. In the late stages of hemophilic arthropathy, the optimal treatment method is total joint replacement. Such operations in patients with hemophilia can only be performed with hemostatic replacement therapy. In most cases, primary endoprostheses are used to preserve the patient’s own bone tissue as much as possible. The 10-year survival rate of primary knee and hip replacements in patients with hemophilia is about 80%. In rare cases, the use of primary endoprostheses is difficult or impossible due to insufficient bone mass: aseptic loosening of the endoprosthesis, periprosthetic fracture, severe deformation of the femoral and tibial epiphyses, hemophilic pseudotumor of the femoral and tibial bones, etc. In such cases, it is necessary to replace the bone defect for a significant length. Modular endoprostheses (mega prostheses, modular endosystems) allow you to replace partially or completely the bone diaphysis. The world literature describes isolated cases of using modular endosystems in patients with hemophilia. It is interesting to share the experience of using a modular endosystem for hip, femur, and knee prosthetics in a patient with severe hemophilia A. References Zorenko V. Yu., Mishin G.V., Severova T.V. et al. Pharmacokinetics, safety, and tolerability of Octofactor in patients with hemophilia A: results of phase I clinical study. Voprosy gematologii/onkologii i immunopatologii v pediatrii. 2013;12(2):30–7. (In Russ.). Davydkin I.L., Andreeva T.A., Zorenko V. Yu. et al. Efficiency and safety of Octofactor in prevention of bleeding episodes in patients with severe and moderate hemophilia A: results of part 1 of phase II–III clinical trial. Voprosy gematologii/onkologii i immunopatologii v pediatrii. 2013;12(3):29–37. (In Russ.). Мишин Г.В., Зоренко В.Ю., Карпов Е.Е. и др. Ревизионное эндопротезирование коленного сустава с замещением части диафиза бедренной кости модульной эндосистемой АМТ у больного с ингибиторной формой гемофилии В. Тромбоз, гемостаз и реология. 2020;(3):99–104. DOI: 10.25555/THR.2020.3.0936. Mishin G.V., Zorenko V. Yu., Karpov E.E. et al. Revision knee arthroplasty with replacement of part of femoral diaphysis with the modular endosystem AMT in a patient with inhibitory hemophilia B. Tromboz, gemostaz i reologiya. 2020;(3):99–104. (In Russ.). DOI: 10.25555/THR.2020.3.0936. Петровский Д.Ю., Зоренко В.Ю., Полянская Т.Ю. и др. Применение транексамовой кислоты у пациентов с гемофилией А при эндопротезировании коленного сустава. Врач. 2020;(7):77–81. DOI: 10.29296/25877305–2020–07–15. Petrovskiy D. Yu., Zorenko V. Yu., Polyanskaya T. Yu. et al. The use of tranexamic acid in patients with hemophilia A during knee replacement. Vrach. 2020;(7):77–81. (In Russ.). DOI: 10.29296/25877305–2020–07–15. Golobokov A.V., Zorenko V. Yu., Polyanskaya T. Yu. et al. A case of surgical correction of anterior foot deformities in a patient with hemophilia A. Vrach. 2020;(6):63–8. (In Russ.). DOI: 10.29296/25877305–2020–06–12. Andreeva T.A., Zorenko V. Yu., Davydkin I.L. et al. Efficiency and safety of Octofactor in the treatment of patients with severe and moderate hemophilia A: results of part 2 of phase II–III clinical trial. Voprosy gematologii/onkologii i immunopatologii v pediatrii. 2013;12(4):31–7. (In Russ.). Nilsson I.M., Berntorp E., Lofqvist T., Pettersson H. Twenty-five years’ experience of prophylactic treatment in severe haemophilia A and B. J Intern Med. 1992;232(1):25–32. DOI: 10.1111/j.1365– 2796.1992.tb00546.x. Hemopathies in outpatient practice. Eds. Prof. I.L. Davydkin. Moscow: GEOTAR-Media, 2020. 272 pp. Zorenko V. Yu., Polyanskaya T. Yu., Karpov E.E. et al. Experience of joint replacement in the management of haemophilic arthropathy. Gematologiya i transfuziologiya. 2017;62(2):70–4. (In Russ.). DOI: 10.18821/0234–5730/2017–62–2–70–74. Massin P., Lautridou C., Cappelli M. et al. Total knee arthroplasty with limitations of flexion. Orthop Traumatol Surg Res. 2009;95(4 Suppl 1): S1–6. DOI: 10.1016/j.otsr.2009.04.002. Solimeno L.P., Mancuso M.E., Pasta G. et al. Factors influencing the long-term outcome of primary total knee replacement in haemophiliacs: a review of 116 procedures at a single institution. Br J Haematol. 2009;145(2):227–34. DOI: 10.1111/j.1365– 2141.2009.07613.x. Goddard N. J., Mann H. A., Lee C. A. Total knee replacement in patients with end-stage haemophilic arthropathy: 25-year results. J Bone Joint Surg Br. 2010;92(8):1085–9. DOI: 10.1302/0301–620X.92B8.23922. Panotopoulos J., Ay C., Trieb K. et al. Outcome of total knee arthroplasty in hemophilic arthropathy. J Arthroplasty. 2014;29(4):749– 52. DOI: 10.1016/j.arth.2013.07.014. Chen A.F., Choi L.E., Colman M.W. et al. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures. J Arthroplasty. 2013;28(9):1580–4. DOI: 10.1016/j.arth.2013.02.030. Sunnassee Y., Wan R., Shen Y. et al. Preliminary results for the use of knee mega-endoprosthesis in the treatment of musculoskeletal complications of haemophilia. Haemophilia. 2015;21(2):258– 65. DOI: 10.1111/hae.12541. Stumpf U.C., Eberhardt C., Kurth A.A. Orthopaedic limb salvage with a mega prosthesis in a patient with haemophilia A and inhibitors — a case report. Haemophilia. 2007;13:435–9. DOI: 10.1111/j.1365–2516.2007.01476.x. Chiang C.C., Chen P.Q., Shen M.C., Tsai W. Total knee arthroplasty for severe haemophilic arthropathy: long-term experience in Taiwan. Haemophilia. 2008;14(4):828–34. DOI: 10.1111/j.1365– 2516.2008.01693.x.