MATTERS
JOINT SURGERY
This has been produced by Bayer
DO
I NEED
JOINT
SURGERY?
Having haemophilia makes you more susceptible to
joint damage that may require surgery. The most
common joints affected by haemophilia are the
hinge joints: elbows, knees and ankles. Specifically,
joint damage is caused by repeated bleeds in and
around the joint tissue. Prophylaxis is therefore an
important option for helping to minimise bleeding.
The mechanics of hinge joints makes them more
susceptible to damage as they can only bend
and straighten. Ball and socket joints such as the
hips and shoulders have more flexibility. They are
therefore less prone to the stresses that can trap
the connective tissue lining joint cavities (called
the synovial membrane) and cause a bleed.
Older people with haemophilia may have a
greater risk of developing joint damage (termed
haemophilia arthropathy), as the treatment for
haemophilia was less advanced when they were
children; these people are more likely to have
suffered joint damage caused by repeated bleeds
when they were young. It is now widely accepted,
however, that joint damage may be minimised by
prophylaxis (preventative treatment involving
early, regular factor treatment).
The symptoms of joint damage include pain and
stiffness with limited flexibility. In most cases,
joint surgery is elective, and even though a joint
may be damaged you do not necessarily have to
have an operation.
WHAT
ARE THE
DIFFERENT
TYPES OF
JOINT
SURGERY?
Several kinds of joint surgery can be conducted,
depending on the nature and extent of joint
damage, as well as the type of joint affected.
The most common joints that need replacing in
haemophilia are the knee and hip joints.
KNEE REPLACEMENT SURGERY
HIP REPLACEMENT SURGERY
SYNOVECTOMY
ANKLE SURGERY (ARTHRODESIS)
ELBOW SURGERY
WHAT
ARE THE
BENEFITS
OF HAVING
JOINT
SURGERY?
Surgery is often used to decrease pain caused
by damaged joint tissue. It can also correct
joint irregularities, and may improve movement
and flexibility.
Knee replacement surgery involves replacing the
damaged joint with metal or plastic components.
This surgery is very effective for pain relief and
may also improve the range of movement at the
joint. Prosthetic knees can last for approximately
15 years.
Hip replacement surgery involves replacing
the whole hip joint with a metal or ceramic ball,
and ceramic cup to act as a new socket. This type
of prosthetic joint can improve mobility, reduce
pain, and the majority last for 10-15 years –
sometimes longer.
Synovectomy is the process of removing, or
burning, the inflamed lining of the damaged
joint tissue. It can be performed using chemicals,
keyhole or open surgery, and is normally
conducted on knee and elbow joints.
Chemical synovectomy is an increasingly
popular and effective alternative to surgery.
Typically, an injection is used to remove the
synovial membrane
Keyhole surgery, performed under general
anaesthetic, leaves a small scar and allows
early rehabilitation and recovery
Open surgery enables the orthopaedic
surgeon to remove all damaged joint tissue.
This surgery, however, leaves a bigger
scar and gives a longer recovery period.
Consequently, other options are beginning
to be favoured over open surgery
Elbow surgery includes synovectomy,
the smoothing down of joint surfaces (joint
debridement) or removal of the radial head to
alleviate pain and improve forearm rotation.
Ankle surgery (arthrodesis) is effective for
pain relief. At present, ankle replacement surgery
and elbow replacement surgery are not used widely
in haemophilia due to poor outcomes worldwide.
Instead, bones in the ankle can be fused together
in order to stop any movement and reduce pain.
Loose bone fragments around the joint can also
be ‘washed out’ with keyhole surgery, and local
anaesthetic and steroids can be injected to reduce
pain. Surgery to remove spikes of bone, as well as
chemical synovectomy, can also be conducted.
You will be given modified footwear following ankle
surgery to help with walking.
HOW WILL
MY SURGERY
DIFFER FROM
THAT OF A
PERSON
WITHOUT
HAEMOPHILIA?
If you decide to have surgery, you will be given
a full explanation of the surgery and its
outcomes. This may include the use of diagrams
or demonstration joints, and factsheets.
As a person with haemophilia, you will receive
factor replacement treatment before, during and
after surgery. Post-surgery physiotherapy will be
timed to coincide with your factor replacement
treatment. The factor levels and any bleeding will
be closely monitored throughout.
WHAT
SUPPORT
WILL I
RECEIVE
BEFORE
AND AFTER
SURGERY?
As a person with haemophilia, you will be given
ample support both before and after your surgery.
To prepare you for your operation, you are
encouraged to:
Discuss your surgical procedure with others
who have had similar procedures.
Exercise, and you will be given advice about
cardiovascular fitness, and specific exercises
to help build up the muscles around your joint,
from your physiotherapist. Exercise can
strengthen your joints and muscles making it
less likely that you will suffer from joint bleeds.
It is also important to increase your fitness
levels, as this will help you to use crutches
during your recovery should you need them.
Your physiotherapist can also give regular
joint assessments and will work with you
following surgery.
Stay healthy. Eating a sensible diet and
maintaining a healthy weight can ease the
pressure, and therefore risk of damage, on load
bearing joints such as the hips, knees and ankles.
For more information, talk to your nurse at your
local haemophilia centre.
You will also be given support for managing any
pain you may experience following surgery.
Before your surgery is conducted, your surgeons
will work together with hospital pharmacists
to create a pain management plan. You may be
given morphine or oral painkillers, and may be
encouraged to ice your joint, using, for example,
a Cryo/CuffTM if you have had ankle surgery.
WHAT
SUPPORT
DOES
BAYER
OFFER?
Additional information
can be found at:
www.factorfitness.co.uk
Bayer is committed to haemophilia research and
supporting people with haemophilia:
Funding research to advance the
successful management of haemophilia
Reducing needle sizes and infusion
volumes to aid infusion
Producing infusion aids such as
stress balls and tourniquets to
support patients with their infusions
Creating leaflets and materials
to support patients through their
journey with haemophilia
Developing the interactive website
www.factorfitness.co.uk
This booklet has been kindly reviewed and endorsed
by Andrew Clements, Specialist Haemophilia Physiotherapist,
University Hospitals of Leicester NHS Trust.
For further information contact:
Bayer plc, Bayer House, Strawberry Hill, Newbury,
Berkshire RG14 1JA. Tel: (01635) 563000.
© Bayer plc May 2016. ® Registered trademark of Bayer AG, Germany.
Bayer and
are trademarks of Bayer AG.
May 2016. L.GB.MKT.03.15332a