Comparative Perioperative Inflammatory and Functional Outcomes in Single Versus Multiple Joint Replacements for Hemophilic Arthritis: A Pilot Study

Abstract

Objective: Hemophilic arthritis is a progressive joint disease often requiring surgical intervention in advanced stages. However, comparative evidence on perioperative inflammatory and coagulation responses between single joint replacement (SJR) and multiple joint replacement (MJR) remains scarce. This study aimed to assess the differences in perioperative outcomes, including inflammatory responses, blood transfusion requirements, and functional recovery, to guide surgical decision-making for hemophilic arthritis patients.

Methods: This retrospective study included 29 male patients with moderate-to-severe hemophilic arthritis who underwent SJR (n = 12) or MJR (n = 17) at a single institution from October 2020 to October 2023. Data on inflammatory markers (CRP, ESR, IL-6, WBC), hemoglobin levels, blood transfusion requirements, and joint mobility were collected for the immediate postoperative period (days 1–14). Trends in inflammatory markers were analyzed using average percent changes (APC), and differences in outcomes were evaluated using the Mann–Whitney U test for continuous variables and Fisher's exact test for categorical variables. Longitudinal changes were analyzed using mixed-model repeated measures ANOVA with time points as fixed effects and subjects as random effects. Statistical significance was set at p < 0.05.

Results: Postoperative CRP levels declined significantly in both groups, with APCs of −9.06% (95% CI: −15.63 to −1.98, p < 0.05) for the SJR group and −8.42% (95% CI: −16.18 to 0.06) for the MJR group. ESR showed a significant upward trend, with APCs of 10.82% (95% CI: 0.95–21.65, p < 0.05) in the SJR group and 17.54% (95% CI: 11.71–23.67, p < 0.05) in the MJR group. Blood transfusion requirements were comparable, with median transfusion volumes of 0.00 units (IQR: 3.50) for SJR and 0.00 units (IQR: 3.75) for MJR (p = 0.761). Notably, joint mobility scores were significantly better in the MJR group (mean: 31.88, SD: 19.31) compared to the SJR group (mean: 18.33, SD: 10.39; p = 0.030). Despite the larger surgical scope of MJR, no significant differences in infection or bleeding risks (SJR:median transfusion = 0.00 units, IQR: 3.50; MJR:median transfusion, 0.00 units, IQR: 3.75. p = 0.761) were observed between the groups.

Conclusion: This study demonstrates that MJR offers superior functional recovery compared to SJR, without increasing the risks of infection, bleeding, or transfusion. These findings support MJR as a safe and effective surgical option for hemophilic arthritis patients when appropriate perioperative management protocols are implemented. Future studies with larger sample sizes and long-term follow-up are needed to validate these results and explore extended outcomes.

Keywords

blood transfusion / hemophilic arthritis / joint replacement / perioperative inflammation / surgical outcomes

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