Surgical Procedures Influenced by Age, Severity, Bleed Frequency, Prophylaxis Use

Analysis of Surgical Procedures in CDC-UDC Data shows Age, Hemophilia Severity, Bleed Frequency, Use of Prophylaxis Associated with Frequency of Synovectomy and Joint Replacement

THSNA 2016 (Chicago, April 14-16): Given the preponderance of joints as a site of bleeding in patients with congenital hemophilia, it is not surprising that some patients ultimately need some invasive or surgical procedure on their joints as they age.  Researchers reported at the Thrombosis and Hemostasis Summit of North America (THSNA) in a poster the results of detailed analysis of the Center for Disease Control and Prevention (CDC) Universal Data Collection (“UDC”) study. They looked at any orthopedic/joint surgical procedures captured from 2000 to 2010 in 14,861 males with hemophilia (age 2+ years) across 130 HTCs. They first looked at synovectomy – a procedure to address overgrown synovial tissue in the joint as a consequence of severe bleeding. Males with hemophilia A, moderate/severe disease, age <20 years, HIV/HCV positive, or who had 2 or more joint bleeds in the prior 6 months were more likely to have a synovectomy; those on routine factor replacement (prophylaxis) were half as likely to have a synovectomy. They then looked at joint replacement (arthroplasty) and joint fusion (arthrodesis). Those age >20, overweight, college-educated, moderate/severe hemophilia, low activity level, HCV positive, with 2 or more bleeds in the past 6 months were more likely to have arthroplasty or arthrodesis; students and those on prophylaxis were 40% less likely to have a procedure. They conclude that some risk factors for surgery are modifiable, meaning that if prophylaxis is used to reduce bleeding rate it might impact need for invasive joint procedures.