BEST-04 | MAJOR ORTHOPEDIC SURGERY WITH EMICIZUMAB: A SERIES OF 22 PATIENTS (40 PROCEDURES) WITH A MID-TERM FOLLOW-UP

G. Daniele¹, C. Carulli¹, S. Linari², L. Pieri², G. Castaman² | ¹Clinica Ortopedica, Azienda Ospedaliero-Universitaria Careggi, Università degli Studi di Firenze, Italy; ²Centro Malattie Emorragiche e della Coagulazione, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy

Introduction. Persons with hemophilia (PWH) needing orthopedic surgery have been managed effectively for a long time with a prophylaxis with specific recombinant factors. Recently, emicizumab was introduced for the prophylaxis in PWH with and without inhibitors. However, major orthopedic surgeries with this regimen have been occasionally performed in very few centers. PURPOSE The aim of the present study is the report of the experience of major orthopedic surgery with emicizumab at a single hemophilia center with a mid-term follow-up.
Materials and Methods. Between 2018 and 2026, 22 PWH (10 with high-titre inhibitors, 12 without inhibitors) underwent 40 orthopedic surgeries: two above-the-knee amputations, sixteen Total Knee Arthroplasty (TKA), five Total Hip Arthroplasty (THA), five revision knee arthroplasty (rTKA), two revision hip arthroplasty (rTHA), two pseudotumor excisions, one knee fusion, five partial knee revisions, and a knee manipulation under anesthesia. The mean age of patients was 54.5 years at the time of each procedure (range: 29-69). Prophylaxis consisted in the association of weekly subcutaneous injections of emicizumab and peri-/post-operative boli of rFVIIa (PWH and inhibitors) or rFVIII (PWH without inhibitors). Clinical parameters of evaluation were VAS, Haemophilic Joint Health Score (HJHS), and dedicated imaging. Follow-up was conducted at 1, 3, and 6 months, and then yearly.
Results. All patients were successfully treated without any complications during surgery. In the postoperative period, three complications were recorded: a patient, affected by a septic complication two months after his pseudotumor excision, underwent an above-the-knee amputation. Another patient, a few days after the TKA, underwent a manipulation under anesthesia for a persistent knee flexion contracture. Finally, one patient required two blood transfusions for a post-operative anemia after a hip revision. The mean follow-up was 38.86 months (range: 3-99). No adverse events were recorded related to the haematological prophylaxis, and all patients were regularly rehabilitated and then discharged. The mean hospital stay was 16.55 days (range: 7-46). All patients reported satisfaction for pain reduction and improved joint and global function, as VAS and HJHS improved scores after surgery confirmed.
Conclusions. A prophylaxis regimen with emicizumab and factor replacement in PWH undergoing major surgery has proved to be safe, ensuring effective bleeding control and good postoperative clinical outcomes at mid-term follow-up.