Dear Addy: Joint Replacement Surgery
I'm a 50-year-old with hemophilia A, who's right elbow has seen better days. I'm in the process of researching all my surgical options before making an appointment with my HTC. At this point in my life I'm really intrigued with an elbow replacement. Do you know of any other results throughout the community?
Serious About the Funny Bone
Dear Funny Bone,
According to the medical community there are two regularly used surgical options for people who suffer from hemophilic arthropathy, or joint abnormality or disease in people with hemophilia. These two surgical options are (1) synovectomy (a procedure to remove the tissue that lines a joint when it becomes inflamed and causes damage that may be done by surgery or by injection of a chemical or radioactive substance into the joint) or (2) total joint arthroplasty or replacement. Where hip and knee surgery are more common than elbow replacement in people with hemophilia, joint replacement in people with hemophilia is considered safe. Referring to a six-year (2006-2012) study of joint replacement in people with hemophilia, the hematologist conducting the study said, “We believe [joint replacement] is a safe and effective procedure in the management of hemophilic arthropathy at hemophilia centers.”[i]
Unlike hips and knees, the elbow is a relatively small joint greatly relying on ligaments for stability. In general, elbow replacement results in more complication than with other joints, like hips and knees.[ii] Depending on the type of implant used, elbow replacements can submit the arm bones to more stress.[iii] As to elbow replacements specifically for you, it is best to ask your hematologist for her/his recommendation. You and your doctor will need to consider the pros and cons of elbow replacement for which common complications include: infection, loosening, wear, triceps weakness, and ulnar neuropathy (numbness or weakness in the ulnar nerve, the same nerve that when struck is what we call hitting your “funny bone”). As to the pros, if you have it on your bucket list to straight your arm again, an elbow replacement might be what the doctor orders.
[i] Hideyuki Takedani (2013). Total Joint Arthroplasty for Hemophilia, Arthroplasty – Update, Prof. Plamen Kinov (Ed.), InTech, DOI: 10.5772/53232.
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HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.
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