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Total Knee Arthroplasty in a Patient With Hemophilic Arthropathy and High-Titer Inhibitors:

A Cost Analysis

  • Jason M. Ali, MRCS

      Affiliations

    • Department of Orthopaedics, Cambridge University Hospital, CB2 0QQ, Cambridge, UK
    • Corresponding Author InformationReprint requests: Jason Ali, MRCS, Department of Orthopaedics, Cambridge University Hospital, CB2 0QQ Cambridge, UK.
    • ,
  • Alan J. Howieson, MRCS

      Affiliations

    • Department of Orthopaedics, Cambridge University Hospital, CB2 0QQ, Cambridge, UK
    • ,
  • Kingsley Lawrence, BSc

      Affiliations

    • Department of Haematology, Cambridge University Hospital, CB2 0QQ, Cambridge, UK
    • ,
  • Dipti Chitnavis, FRCPath

      Affiliations

    • Department of Haematology, West Suffolk Hospital, Bury St Edmunds, Suffolk, IP33 2QZ
    • ,
  • Jai Chitnavis, FRCS

      Affiliations

    • Department of Orthopaedics, Cambridge University Hospital, CB2 0QQ, Cambridge, UK

Received 29 October 2010; accepted 25 September 2011. published online 09 December 2011.
Corrected Proof

Abstract 

A patient with hemophilia A, who developed factor VIII inhibitors and initially had funding for his total knee arthroplasty declined, is discussed. A total of £1 542 000 (US $2 474 603) was spent on medical treatment for recurrent hemarthroses over a 4-year period, while funding was sought. In comparison, the total cost for his knee arthroplasty was £542 858 (US $871 084) including perioperative recombinant clotting factors. Postoperatively, with 1-year follow-up, no further hemoarthroses have occurred; his analgesic requirement is significantly reduced; he has a much improved level of function; and treatment costs are significantly reduced, leading to a substantial overall saving. Our findings suggest that surgical treatment is beneficial and cost-effective for patients with hemophilia with inhibitors. Hospitals should not deny operative treatment based on cost alone.

Keywords: hemophilic arthropathy, FEIBA, knee replacement, cost analysis, factor VIII inhibitors

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 The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.09.029.

PII: S0883-5403(11)00569-9

doi:10.1016/j.arth.2011.09.029

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