Total Knee Arthroplasty in Severe Hemophilic Arthropathy With Stiff Knees(Preoperative Flexion Range of Motion ≤40°): Functional Outcomes and Long‐Term Survivorship

Aim This study aimed to evaluate the clinical and radiographic outcomes of total knee arthroplasty (TKA) in patients with haemophilia A and severely stiff knees (preoperative flexion range of motion ≤40°) with a focus on functional recovery, implant stability, and complication rates. Methods Twenty‐four patients (31 knees) with severe haemophilia A and severely stiff knees (mean age: 38.4 years; range: 24–61 years) underwent TKA using the medial parapatellar approach and Posterior Stabilised prostheses. Knee ROM and flexion contracture were assessed preoperatively and at the latest follow‐up. Radiographic analysis evaluated component stability, joint alignment, deformity correction, and postoperative complications. Long‐term implant survivorship was assessed using Kaplan‐Meier analysis. Results Over an average follow‐up of 7.2 years (range: 3.2–14.8 years), no cases of prosthetic loosening, instability, or axial deformity were found except in two knees. Complications occurred in three patients (9.7%): one late periprosthetic joint infection requiring revision, one superficial wound infection resolved conservatively, and one aseptic loosening requiring revision. Knee flexion improved from 42.8° to 81.3° and flexion contracture from 16.2° to 5.8° (both p < 0.001). Ten‐year implant survivorship was 93.4% (95% CI: 86.1–97.2%). Conclusion TKA appears to be a safe and effective intervention for haemophilia patients with severely stiff knees, offering substantial functional recovery, enhanced joint mobility, and a low complication profile. Earlier intervention in patients with flexion >30° may optimise outcomes.