{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:15:39Z","timestamp":1786738539274,"version":"build-2736575974"},"reference-count":42,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Operations on patients with hemophilia A and B are complex. Studies evaluating postoperative outcomes and costs following total knee arthroplasty (TKA) in patients with hemophilia are limited. A retrospective review of the entire Medicare dataset from 2005 to 2014 was performed. International Classification of Disease 9th revision codes were used to identify patients with hemophilia A and B and they were matched to controls using a 1:1 random matching process based on age, gender, Charlson Comorbidity Index (CCI), and select comorbidity burden. The 90-day preoperative period was evaluated for comorbidities and the 90-day postoperative period was analyzed for outcomes and reimbursements. Logistic regression models were generated to compare outcomes between cases and controls. A total of 4,034 patients with hemophilia were identified as having undergone TKA. About 44.8% were between the ages of 65 and 74 and 62.4% were female. Although the CCI was identical in both cohorts, individual comorbidities not controlled for varied significantly. Medical complications were more frequent among the patients with hemophilia: postoperative bleeding (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.2\u20132.3), deep venous thrombosis (OR: 2.3; 95% CI: 1.8\u20132.8), pulmonary embolism (OR: 2.9; 95% CI: 2.1\u20133.9), and blood transfusions (OR: 1.8; 95% CI: 1.6\u20131.9). Hemophilia was associated with higher odds of periprosthetic infection (1.78 vs. 0.98%, OR: 1.8 95% CI: 1.2\u20132.7). The 90-day reimbursements were higher for patients with hemophilia (mean: $22,249 vs. $13,017, p\u2009&lt;\u20090.001). Medicare beneficiaries with a diagnosis of hemophilia experience more frequent postoperative complications and incur greater 90-day costs than matched controls following TKA. Surgeons should consider this when optimizing patients for TKA and payors should consider this for risk-adjusting payment models.<\/jats:p>","DOI":"10.1055\/s-0039-1696691","type":"journal-article","created":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T22:53:06Z","timestamp":1568069586000},"page":"372-377","source":"Crossref","is-referenced-by-count":9,"title":["Total Knee Arthroplasty among Medicare Beneficiaries with Hemophilia A and B Is Associated with Increased Complications and Higher Costs"],"prefix":"10.1055","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7330-3753","authenticated-orcid":false,"given":"Samuel","family":"Rosas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5633-0020","authenticated-orcid":false,"given":"Leonard T.","family":"Buller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Plate","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Higuera","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael K.","family":"Barsoum","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Florida, Weston, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Emory","sequence":"additional","affiliation":[{"name":"Department of 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Type 2 diabetes mellitus have a worse functional outcome post knee arthroplasty: a matched cohort study","volume":"19","author":"F Robertson","year":"2012","journal-title":"Knee"},{"issue":"10","key":"ref4","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1016\/j.arth.2014.05.024","article-title":"The effect of body mass index on outcome in total hip arthroplasty: early analysis from the New Zealand Joint Registry","volume":"29","author":"S E Murgatroyd","year":"2014","journal-title":"J Arthroplasty"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.arth.2015.02.023","article-title":"Total knee arthroplasty within six months after knee arthroscopy is associated with increased postoperative complications","volume":"30","author":"B C Werner","year":"2015","journal-title":"J Arthroplasty"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.2106\/JBJS.H.00116","article-title":"The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty","volume":"91","author":"M H Marchant Jr","year":"2009","journal-title":"J Bone Joint Surg Am"},{"issue":"13","key":"ref7","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.2106\/JBJS.N.01016","article-title":"The effect of smoking on short-term complications following total hip and knee arthroplasty","volume":"97","author":"K R Duchman","year":"2015","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11999-014-3668-9","article-title":"The John Insall Award: Morbid obesity independently impacts complications, mortality, and resource use after TKA","volume":"473","author":"M R D'Apuzzo","year":"2015","journal-title":"Clin Orthop Relat Res"},{"issue":"08","key":"ref9","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/j.arth.2015.02.028","article-title":"Alcohol misuse is an independent risk factor 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Rosas","year":"2017","journal-title":"J Shoulder Elbow Surg"},{"issue":"07","key":"ref28","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/j.arth.2017.02.039","article-title":"Medical comorbidities impact the episode-of-care reimbursements of total hip arthroplasty","volume":"32","author":"S Rosas","year":"2017","journal-title":"J Arthroplasty"},{"issue":"04","key":"ref29","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.jse.2013.12.006","article-title":"The influence of psychiatric comorbidity on perioperative outcomes after shoulder arthroplasty","volume":"23","author":"A G Bot","year":"2014","journal-title":"J Shoulder Elbow Surg"},{"key":"ref30","first-page":"50","volume-title":"Joint replacement surgery in hemophilia","author":"J Wiedel","year":"2010"},{"issue":"S 03","key":"ref31","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/j.1365-2516.2010.02254.x","article-title":"Wound healing in haemophilia--breaking the vicious 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