Declining trends in invasive orthopedic interventions for people with hemophilia enrolled in the Universal Data Collection program (2000-2010)

Abstract

Introduction: Recurrent joint hemarthroses due to hemophilia (Factor VIII and Factor IX deficiency) often lead to invasive orthopedic interventions to decrease frequency of bleeding and/or to alleviate pain associated with end-stage hemophilic arthropathy.

Aim: Identify trends in invasive orthopedic interventions among people with hemophilia who were enrolled in the Universal Data Collection (UDC) program during the period 2000-2010.

Methods: Data were collected from 130 hemophilia treatment centers in the United States annually during the period 2000-2010, in collaboration with the Centers for Disease Control and Prevention (CDC). The number of visits in which an invasive orthopedic intervention was reported was expressed as a proportion of the total visits in each year of the program. Invasive orthopedic interventions consisted of arthroplasty, arthrodesis, and synovectomy. Joints included in this study were the shoulder, elbow, hip, knee, and ankle.

Results: A 5.6% decrease in all invasive orthopedic interventions in all joints of people with hemophilia enrolled in the UDC program over the 11-year study period was observed.

Conclusions: These data reflect a declining trend in invasive orthopedic interventions in people with hemophilia. Further research is needed to understand the characteristics that may influence invasive orthopedic interventions.

Keywords: arthropathy; arthroplasty; hemophilia; orthopedic.

Fig. 1

All invasive orthopedic interventions (arthrodesis, arthroplasty, synovectomy, and other) summed over all joints. Other, represents a non-specific group of invasive orthopedic interventions not categorized as arthrodesis, arthroplasty or synovectomy.

Fig. 2

All invasive orthopedic interventions (arthrodesis, arthroplasty, synovectomy, and other) by diagnosis. Other, represents a non-specific group of invasive orthopedic interventions not categorized as arthrodesis, arthroplasty or synovectomy.

Fig. 3

All invasive orthopedic interventions (arthrodesis, arthroplasty, synovectomy, and other) by hemophilia severity. Figure excludes 75 individuals whose severity was unknown. Other, represents a non-specific group of invasive orthopedic interventions not categorized as arthrodesis, arthroplasty or synovectomy.

Fig. 4

All invasive orthopedic interventions (arthrodesis, arthroplasty, synovectomy, and other) by age groups (in years). Other, represents a non-specific group of invasive orthopedic interventions not categorized as arthrodesis, arthroplasty or synovectomy.

Fig. 5

All invasive orthopedic interventions (arthrodesis, arthroplasty, synovectomy, and other) by inhibitor status. Inhibitor negative is no reported inhibitor presence in the year prior to and year of an orthopedic intervention. Inhibitor positive is presence of inhibitor the year prior to and year of an orthopedic intervention. Other, represents a non-specific group of invasive orthopedic interventions not categorized as arthrodesis, arthroplasty or synovectomy.

Fig. 6

All invasive orthopedic interventions (arthrodesis, arthroplasty, synovectomy, and other) by factor use. ‘On demand’ is defined as intermittent use of factor replacement as recorded by the Universal Data Collection (UDC) program in the year prior to and year of an invasive orthopedic intervention. Continuous prophylaxis is defined recorded continuous prophylaxis by the UDC program in the year prior to and year of an invasive orthopedic intervention. Other, represents a non-specific group of invasive orthopedic interventions not categorized as arthrodesis, arthroplasty or synovectomy.