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JB JS Open Access. 2018 Oct 23;3(4):e0026. doi: 10.2106/JBJS.OA.18.00026. eCollection 2018 Dec 20.

Comparison of 90-Day Complication Rates and Cost Between Single and Multiple Joint Procedures for End-Stage Arthropathy in Patients with Hemophilia.

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Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China.



Multiple joint procedures during a single anesthetic episode have been proposed for patients with hemophilia as a way to reduce cost. The postoperative 90-day complication rate and the cost distribution between multiple joint procedures and single joint procedures for patients with hemophilia have not been well studied.


Between January 1996 and December 2016, 124 patients underwent 177 surgical procedures (total knee arthroplasty, total hip arthroplasty, and ankle arthrodesis) for the treatment of hemophilic end-stage arthropathy. Forty-eight patients (39%) underwent multiple joint procedures during 1 hospitalization, and 76 patients (61%) underwent single joint procedures. The medical records were retrospectively reviewed. The patients were evaluated for complications within 90 days postoperatively and the cost during hospitalization. Risk factors related to complications were further analyzed.


Twenty-seven of the 124 patients experienced 29 complications within 90 days postoperatively, representing a complication rate of 16.4% for all procedures. The patients who had undergone multiple joint procedures had a higher rate of surgical complications than those who had undergone a single joint procedure (14.6% vs. 3.9%; p = 0.039). The patients who had had multiple joint procedures had similar rates of hematological complications (8.3% vs. 9.2%; p = 0.867) and total complications (31.3% vs. 18.4%; p = 0.100) compared with those who had had a single joint procedure. There was no difference between the patients who had had multiple joint procedures and those who had had a single joint procedure with regard to the cost of the coagulation factor (p = 0.212).


The performance of multiple joint procedures during a single anesthetic episode is a safe approach for patients with hemophilia with end-stage arthropathy, with no substantial increase in the 90-day complication rate in comparison with that following a single joint procedure. The performance of multiple joint procedures under a single anesthetic episode can save cost and is more cost-effective when managing patients with hemophilia who have end-stage arthropathy.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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