World Hemophilia Day is celebrated on 17 April, and this year's theme is "For All – Solidarity, Policy Support, Common Development". With multidisciplinary teamwork, since 2020, the Joint Center of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine has completed joint replacement surgery for 6 patients with hemophilia, two of whom have performed joint replacement in two parts at the same time.
Due to the lack of hereditary coagulation factors, patients with hemophilia often bleed uncontrollably after accidental injury, and spontaneous bleeding can also occur after activity, if the bone and joint bleed repeatedly, causing hemophilic arthritis, joint swelling, pain, dysfunction, affecting normal life.
He Wei, chief physician of the Joint Center of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine and chief professor of the Guangdong Institute of Traditional Chinese Medicine Orthopedic Injury, said that patients with hemophilia should go to a hematology specialist in time to standardize the supplementation of coagulation factors to avoid repeated bleeding of large joints throughout the body and cause arthritis. For patients whose diseases have seriously affected the joints, under the premise of full preparation, artificial joint replacement surgery can effectively relieve pain, improve function, improve quality of life and work ability.
For patients with hemophilia who can stop bleeding with minor trauma, how to perform joint replacement surgery in the face of possible complications such as long surgery time, heavy bleeding, and postoperative bleeding?
"Fake tigers must also be beaten as real tigers!" He Wei said doctors must consider any risks that may arise during the perioperative period of patients. For example, preoperative patients need to be monitored for in vivo coagulation factors, adjusted to the level of tolerance for surgery before treatment; during surgery to reduce the time of surgery, improve the quality of operation, thereby reducing the amount of bleeding; postoperative quantitative supplementation of clotting factors according to requirements, and improve function with the help of rehabilitation therapists.
Scene of total hip arthroplasty in the First Hemophilia Patient of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine. Courtesy of the hospital
The success of joint replacement surgery in patients with hemophilia is inseparable from multidisciplinary team collaboration, close cooperation, safe and effective implementation of joint replacement, and can be replaced by multiple joints at a time, saving costs, reducing pain and increasing benefits for patients.
Chen Qunqun, deputy chief physician of the Joint Center of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, said that in order to successfully carry out artificial joint replacement surgery for patients with hemophilia arthritis, in addition to the surgical skills and clinical experience of the surgical team, it also requires the close cooperation of the anesthesiologist team and the nursing team.
Zhang Xinjian, deputy director of the Department of Anesthesiology of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, pointed out that ensuring that hemophilia patients receive surgical treatment smoothly under painless and safe conditions is the most basic task of anesthesiologists, in addition, it is also necessary to formulate a targeted medication process, closely monitor the coagulation situation around the whole process of surgery, confirm that the main surgeon performs surgery under adequate coagulation factor protection, and does a good job in the intraoperative "blood preservation" program for hemophilia patients.
Completion of joint replacement surgery in patients with hemophilia is only the beginning, and postoperative rehabilitation is equally important. For example, He Wei explained that for most long-term patients, in addition to severe deformities and bone defects in the knee joint, the surrounding soft tissues are also widely affected, and they are in a non-functional position for a long time, and some may completely lose the function of walking and extension and flexion, the muscles are seriously atrophied, and the functional rehabilitation is very difficult.
The early postoperative period is the golden period of rehabilitation, but patients with hemophilia are prone to wound bleeding, which affects healing at worst and wound infection at worst, resulting in surgical failure. Therefore, in the rehabilitation stage, it is still necessary to coordinate with multidisciplinary experts such as orthopedics, rehabilitation, hematology, pain and other multidisciplinary experts to formulate an individualized rehabilitation plan, and dynamically adjust according to the progress of rehabilitation and the control of hemophilia to maximize rehabilitation. (Li Yimeng)
