Long-term prosthesis survival of total hip and total knee arthroplasty in people with inherited bleeding disorders

Background: Joint arthroplasty provides pain relief and functional improvement, but higher peri- and postoperative risks in people with bleeding disorders historically lead to lower prosthesis survival rates (PSRs) than in the general population. Long-term outcomes after advances in hemophilia care remain unclear. In people with bleeding disorders, PSR is 84.0% at 15 years after total knee arthroplasty (TKA) and 91.9% at 5 years after total hip arthroplasty (THA), compared with 92.8% and 93.7% in the general population. Objectives: To determine PSRs of TKA and THA up to 25 years after surgery in people with end-stage hemophilic arthropathy and to identify predictors for prosthesis failure. Methods: This single-center study analyzed routine-care data of people with bleeding disorders (1989-2025), with first revision as the endpoint. PSRs and predictors were assessed using Kaplan-Meier and Cox proportional hazards models. Complete follow-up data on pre-, peri- and postoperative characteristics were evaluated; all variables with a univariable P < .1 were included in multivariable models. Results: A total of 128 TKAs and 64 THAs were included. The PSR for TKA in people with bleeding disorders was 92.2% (number at Risk [nR] = 71; 95% CI, 87.5-97.3) after 15 years and 90.9% (nR = 28; 95% CI, 85.5-96.6) after 25 years. The PSR for THA in people with bleeding disorders was 91.0% (nR = 27; 95% CI, 82.8-100) after 15 years and 78.6% (nR = 14; 95% CI, 64.8-95.5) after 25 years. Prosthetic joint infection, more common in patients with an inhibitor, predicted TKA failure. A cemented femoral stem, associated with a higher age, predicted THA failure. Conclusion: The prothesis survival rate of TKA and THA for people with bleeding disorders with end-stage hemophilic arthropathy was comparable to that of the general population in the literature.