Understanding the risks of total hip arthroplasty in patients with von Willebrand's disease

Purpose: Patients with von Willebrand's disease (VWD) have either a qualitative or quantitative deficiency in a key clotting protein called von Willebrand's factor. Type ROMAN NUMERAL ONE disease is the most common variant, but its clinical implications in total hip arthroplasty (THA) are unclear. Our purpose is to describe the perioperative impact of VWD in THA. Methods: We retrospectively reviewed a total of 17 primary THAs in 14 patients with type ROMAN NUMERAL ONE VWD performed between 2008 and 2019. Almost all cases (88%) received tranexamic acid, and most (59%) received DDAVP. All patients had a direct anterior approach (DAA) THA. Results: None of these cases required a blood transfusion. Mean estimated blood loss was 229 mL, and the mean hemoglobin dropped from 13.9 g/dL to 10.2 g/dL. There were no major bleeding complications. After a mean follow-up of 4 years, the mean hip disability and osteoarthritis outcome score, junior (HOOS, JR) was 79, and there were no reoperations or revisions for any cause. Conclusion: Patients with type ROMAN NUMERAL ONE VWD do not experience severe bleeding with routine chemoprophylaxis combined with DAA THA.