Postoperative bleeding adversely affects total knee arthroplasty outcomes in hemophilia

•Total knee arthroplasty (TKA) is associated with functional improvement for advanced hemophilic arthropathy.•Nearly a third (34%) of patients experience major postoperative bleeding complications (hemarthrosis, hemorrhagic bullae, hematoma formation, prolonged wound bleeding).•Hemophilia patients with early bleeding after TKA have worse long-term functional outcomes.•Early bleeding causes lesser improvements in range of motion, flexion contracture, and knee function scores. Hemophilic arthropathy can result in severe degenerative arthritis and functional limitations in the knees of relatively young patients. Total knee arthroplasty (TKA) provides pain relief and gain of function in advanced-stage hemophilic arthropathy cases. However, little is known about the long-term effects of early major postoperative bleeding (MPOB) in people with hemophilia (PWH). The aim of this study was to evaluate the effects of early MPOB on the final functional outcome, complications, and implant survival of TKA in a single-center hemophilia cohort. PWH who underwent TKA between 1998 and 2019 in a single center were reviewed. Demographic data, clinical data, and radiographic images were evaluated. Hospital for Special Surgery (HSS), Knee Society Score (KSS), and Knee Society Function Score (KSS-F) scores were used to determine function. Patients with early bleeding complications (wound dehiscence, ecchymosis, hemarthrosis, hematoma formation, prolonged or recurrent bleeding attacks) were defined as the bleeding group. Patients who did not experience these complications were assigned to the control group. The bleeding group was compared with controls. Survival of the primary arthroplasty was analyzed by Kaplan–Meier curves. Forty-five TKAs in 29 patients were included in the study. TKA led to an increase in the mean range of motion from 46.08° to 84.59° (P