1/8. Successful use of recombinant factor viia for hemostasis during total knee replacement in a severe hemophiliac with high-titer factor viii inhibitor.A 32-year-old male patient with severe factor viii (FVIII) deficiency had developed a high-titer FVIII inhibitor at age 13. Recurrent hemarthroses caused bony destruction in both knees, significantly impairing his ability to walk. knee examination revealed 20 degrees of varus, destruction of the medial joint line, and flexion contracture. Total knee arthroplasty was performed using recombinant factor viia (rFVIIa, NovoSeven) for hemostatic control. rFVIIa (85 microg/kg given intravenously over 3-5 minutes) was given just prior to surgery. The dose was repeated every 2 hours during and for the first 48 hours after surgery. When the tourniquet was removed, rFVIIa had not been infused for 1.5 hours, and significant hemorrhage was noted. The hemorrhage responded promptly to rFVIIa infusion. The infusion interval was extended to every 4 hours for an additional 48 hours, and subsequent doses were given every 6 hours until the patient returned to the clinic 2 days postdischarge. Hemoglobin levels dropped from 16.9 gm/dL on admission to 9.1 gm/dL at discharge. After 2 months, the patient returned to work. We recommend that tourniquet release be performed immediately after rFVIIa administration and that aggressive physical therapy be considered in the early postoperative period when rFVIIa infusions are frequent.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. An unusual meniscal ganglion cyst that triggered recurrent hemarthrosis of the knee.A 58-year-old woman suffered spontaneous recurrent hemarthrosis of the knee. In the clinical course, pigmented villonodular synovitis was mostly suspected, but in arthroscopic surgery the lateral meniscus appeared to be upturned and stuck into the lateral pouch with the meniscal ganglion cyst. It was suggested that meniscal tear with meniscal ganglion cyst was related with recurrent hemarthrosis. Generally, both the meniscal ganglion cysts and spontaneous recurrent hemarthrosis are highly rare conditions. In this case, we speculated that a negligible power could induce the meniscal tear with recurrent hemarthrosis in the particular situation in which the meniscal ganglion cyst existed. In other words, the meniscal ganglion cyst might basically and physically relate with hemorrhagic condition. Arthroscopically, the meniscal ganglion cyst was removed together with the anterior segment of the lateral meniscus. Recurrent hemarthrosis was treated successfully by resection of the meniscus.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Arthropathy and surgery in congenital factor vii deficiency.A 35-year-old woman with severe (less than 1 percent) factor vii deficiency had recurrent hemarthroses involving the left knee, leading to deformity, pain, and virtually complete loss of function. It was elected to perform a total knee replacement. In preparation for surgery, the patient received heat-treated prothrombin complex concentrate containing 870 units of factor VII per vial. A dose of 50 U/kg raised the factor VII level to 115 percent. At surgery, dense adhesions were found within the joint, the articular cartilage was overgrown with pannus extending out to the lateral patella, and there was extensive deformity of the femoral condyle and tibial plateau. The joint was excised and replaced by a cemented Microloc prosthesis. Postoperatively, factor VII levels were maintained above 10 percent by six-hourly infusions of concentrate. Beginning on Day 4, single daily infusions of 25 U/kg were given prior to physical therapy. No bleeding occurred, and the patient was ambulating at the time of discharge 20 days postoperatively. This experience indicates that despite its short half-life (less than four hours), factor VII levels sufficient to prevent bleeding can be maintained in factor VII-deficient patients undergoing major operative procedures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Synovectomy and continuous passive motion (CPM) in hemophiliac patients.Synovectomy of the knee is a procedure that has been used traditionally for the management of arthropathies due to intraarticular bleeding diatheses. Although open synovectomy controls recurrent bleeding problems, the success of this procedure has been limited frequently by disabling stiffness of the joint. In an attempt to improve on the results of open synovectomy, arthroscopic synovectomy was combined with continuous passive motion (CPM) in a prospective surgical and rehabilitation program. Five male patients aged 10 to 35 years, with chronic and/or recurrent hemarthroses due to hemophilia, underwent arthroscopic synovectomy of the knee. CPM was begun in the recovery room and continued for 5-7 days. Each patient had mildly restricted range of motion (ROM) immediately postoperatively as compared with preoperative measurements. Both active and passive ROM improved rapidly with CPM and physical therapy. By 3-6 months postoperatively, all patients except one had achieved an active ROM greater than the preoperative range, and all showed a significant reduction in documented bleeding episodes. The combination of arthroscopic techniques, which result in minimal extraarticular trauma, and immediate mobilization using CPM has been successful in maximizing the benefits and minimizing the complications of synovectomy in the patient with hemorrhagic arthropathy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Hemophiliac knee: rehabilitation techniques.Hemophilia is an inherited bleeding disorder which produces its greatest morbidity in the musculoskeletal system. This article reviews current rehabilitation techniques for the hemophiliac knee--including restrictions of physical activity, external support, and corrective orthotic devices--reports our experience using aggressive strengthening techniques in 2 children, and compares the effectiveness of the 2 methods. It is the impression of the authors that strengthening, rather than immobilization, can bring about increased range of motion, increased strength, and decreased bleeding frequency.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. A 26-year-old hiv-positive hemophiliac with knee pain.The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. ecchymosis of the lower leg. A sign of hemarthrosis with synovial rupture.Four patients with hemarthrosis of the knee, synovial rupture, and ecchymoses are reported. The patients presented with calf pain and swelling and large ecchymoses, which eventually extended to the ankle as a crescent about one or both malleoli. Appreciation of this physical sign, which appears to be characteristic for the hemorrhagic subset of synovial rupture, should alert the physician to the correct diagnosis and steer him away from contraindicated anticoagulant therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Recurrent spontaneous hemarthrosis associated with reflex sympathetic dystrophy.reflex sympathetic dystrophy is a mysterious entity with unclear pathogenesis. The diagnosis is largely clinical and based on signs and symptoms of pain and vasomotor dysfunction. Treatment is a challenge because the underlying mechanism remains unknown. Our patient is a 75-year-old woman 2 years after left total knee replacement who presented with her second spontaneous hemarthrosis in 3 months. After arthrocentesis, dusky discoloration, edema, hyperesthesia, and decreased range of motion of the left knee and entire distal extremity were noted. Despite analgesia and physical therapy her symptoms worsened. Radiographs of her left knee showed severe periprosthetic osteopenia and a triple phase bone scan was negative. Clinically, reflex sympathetic dystrophy was considered likely and a lumbar sympathetic block was performed. The patient improved and continued to do well after a series of blocks. This is the first reported case of recurrent atraumatic hemarthrosis associated with reflex sympathetic dystrophy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |