Prophylactic Factor Replacement Versus on‐Demand Factor Replacement Following Primary Total Knee Arthroplasty in Patients With Hemophilia: A Retrospective Study With an Average 10‐Year Follow‐up

BACKGROUND: The long-term benefits of prophylactic factor replacement following total knee arthroplasty in patients with hemophilia remain insufficiently evaluated. METHODS: This retrospective cohort study included 70 patients (108 knees) with hemophilia A or B who underwent primary total knee arthroplasty (TKA) between January 2003 and October 2020. Based on their long-term postoperative pattern of factor replacement therapy, patients were classified into the prophylactic group and the on-demand group. Patient-reported outcomes (WOMAC, VAS, FJS-12, and satisfaction scores) were compared between the two groups. Kaplan-Meier survival analysis was conducted to compare prosthesis survival between groups. RESULTS: Over a mean follow-up period of 9.7 years (range, 5 to 22 years), the prophylaxis group demonstrated superior clinical outcomes compared to the on-demand group, with lower WOMAC total scores (14.9 vs. 20.1, p = 0.03) and higher satisfaction scores (17.7 vs. 15.2, p < 0.01), greater ROM (93.5° vs. 60.3°, p < 0.01), and less flexion contracture (5.3° vs. 13.0°, p < 0.01). Kaplan-Meier survival analysis indicated superior prosthesis survival in the prophylaxis group (HR = 0.19, 95% CI: 0.06-0.56, p = 0.01). Restricted cubic spline (RCS) demonstrated that when the annual joint bleeding rate (AJBR) exceeded 4 episodes per year, the odds ratio for adverse clinical outcomes was greater than 1. CONCLUSION: Long-term prophylactic factor replacement after primary TKA seemed to optimize surgical outcomes and improve prosthesis survival. However, due to the limitations of this study, its conclusions should be confirmed by future, better-designed studies (prospective, double-blind, randomized).