Total knee arthroplasty for hemophilia patients with intramedullary nails via 3D-printed patient-specific instruments: a case report and literature review

Background : Total knee arthroplasty (TKA) is the mainstay of treatment for end-stage hemophilia arthritis (HA). In patients fitted with femoral intramedullary nails, TKA is more challenging because of the inability to perform femoral intramedullary positioning. Case presentation : We report a 50-year-old man with hemophilia B. He had undergone intramedullary nail internal fixation of a left femur fracture and internal fixation of a left patella fracture due to trauma. On admission, he had a visual analogue scale (VAS) score of 3 and a joint range of motion (ROM) between 10° and 20°. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was 35. To perform TKA, we used 3D-printed patient-specific instrumentation (PSI) to assist in distal femoral osteotomy, and the remaining surgical steps were performed as usual. At 6 months postoperatively, the patient's ROM in the left knee was 0–60°, the VAS score was 0, and the WOMAC score was 13. At 12 months postoperatively, the patient's ROM in the left knee was 0–70°, the VAS score was 0, and the WOMAC score was 12. Conclusion : PSI provides an effective solution for performing TKA in patients who are unable to undergo femoral intramedullary localization. Future studies should focus on long-term follow-up and postoperative monitoring to further validate the efficacy and safety of the PSI technique in this specific population.