Times of India
14 October 2011
By , Umesh Isalkar
Pune , India

Sushil Sathe had been suffering from bleeding disorder haemophilia since childhood. The 30-year-old was crippled in both the lower limbs due to an accident and also suffered from severe osteoarthritis. Braving all odds, Sathe underwent a bilateral total knee replacement surgery using a technique that reduced bleeding during the operation and enabled fast recovery.

“The presence of haemophilia, the hereditary abnormality that impairs the body’s ability to control blood clotting or coagulation, made the surgery an extremely challenging job,” said orthopaedic surgeon Nikhil Likhate who carried out the critical surgery with haematologist Shashikant Apte at Sahyadri Hospital on May 18. The surgery lasted for four hours. The patient was discharged eight days after the surgery.

As compared to normal cases, the incidence of intra-operative bleeding is very high in patients with haemophilia. Two months after the challenging surgery, Sathe is back on his feet leading a normal life.

“Due to this disorder, I had repeated attacks of bleeding into the left knee (hemarthrosis). Even a trivial trauma would result in debilitating pain,” said Sathe. As age progressed, Sathe developed osteoarthritis of both the knee joints. Because of haemophillia, he was not able to go about his daily routine and lead a normal independent life. Walking short distances was an uphill task.

“Added to this trauma, I met with an accident and fractured my right knee joint in 2007. Ever since, I became almost immobile. The left knee was severely worn out due to osteoarthrities and attacks of bleeding, and the right knee was seriously damaged in the accident. I could not stand even for 10 minutes. Walking for five minutes would cause tremendous pain and fatigue,” Sathe said.

Likhate said, “Huge bone loss, rigidity of the joints and gross deformity are major challenges that we have to deal with while operating on such patients. So to restore the entire normal anatomy or bone structure, I had to use customised zigs which are instruments which help in improving the surgery results. Besides special instrumentation and implants which are normally used only for revision and re-revision joint replacement surgery were also used to offer the patient a good, stable and durable artificial joint. Both the joints had to be done at the same time to minimise the cost of haemophiliac factor which is very expensive.”

“We infused anti-haemophilia factor to control bleeding. The factor was assessed at regular intervals to keep the bleeding under control during and after surgery. It requires medical as well as surgical expertise to tackle such problems,” said haematologist Shahshikant Apte.

Rehabilitation started soon after the surgery. “I started walking by myself with the help of a walker on day five and became independent of all walking aid by the sixth week post surgery,” said Sathe.

What is hemarthrosis? A person suffering from hemarthrosis has bleeding inside a joint. The bleeding is usually caused by an injury, which damages blood vessels in the joint. The vessels bleed, resulting in a collection of blood inside the joint. Hemarthrosis is more common in those with a bleeding disorder, such as hemophilia as well as among those who have severe injury to the joint.

Symptoms of hemarthrosis S ymptoms of hemarthrosis include joint swelling and joint pain. Symptoms of hemophilia include prolonged bleeding, bleeding into the joints, joint swelling, joint pains, knee pain, bleeding gums, fatigue, nose bleeding, excessive bruising, blood in the stool, black stool, and a rash that looks like bruises or broken blood vessels.

(Source: Orthopaedic Department, Sahyadri Hospital, Pune)
Incidence of intra-operative bleeding is very high in patients with haemophilia