Simultaneous bilateral total knee arthroplasty in severe hemophilia: a retrospective cost-effectiveness analysis.
INTRODUCTION
Simultaneous bilateral total knee arthroplasty (TKA) is proposed in the general population as an alternative to staged bilateral TKA and has the advantage of reducing costs with equivalent complication rates. The aim of this study was to evaluate the cost-effectiveness of this alternative in a population of patients with severe hemophilia.


HYPOTHESIS
Simultaneous bilateral TKA is less expensive than staged bilateral TKA.


MATERIALS AND METHODS
We performed a retrospective case control study in patients with severe hemophilia A to compare the direct costs of coagulation factors, the length of hospital stay and sick leave as well as the clinical outcome (KKS) of simultaneous bilateral TKA (group 1; G1: 5 patients) and staged bilateral TKA (group 2; G2: 12 patients).


RESULTS
The mean cost of coagulation factors was 65,880 € in G1 and 139,000 € in G2 (P<0.001). The length of the hospital stay (24 days vs 44 cumulative days, respectively) and sick leave (105 days vs 183 cumulative days, respectively) was significantly reduced in G1. There was no significant difference in clinical outcome at the final follow-up. One patient in G2 had a late knee infection.


DISCUSSION
Simultaneous bilateral TKA in severe hemophilia is associated with lower costs than staged bilateral TKA with equivalent clinical results.


LEVEL OF EVIDENCE
Level 3, case control study.
['Thès|A|A|', 'Molina|V|V|', 'Lambert|T|T|']
D000328:Adult D019645:Arthroplasty, Replacement, Knee D003362:Cost-Benefit Analysis D005260:Female D006467:Hemophilia A D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D020370:Osteoarthritis, Knee D012189:Retrospective Studies D055815:Young Adult
Hemophilia A Bilateral knee replacement Cost-benefit analysis Simultaneous total knee arthroplasty