Case Report of Acupotomy Release Combined with Manual Release Under Anesthesia for Adhesions After Unilateral Total Knee Arthroplasty in a Patient with Hemophilia A

Wei Wang¹Xiaochan Xu¹Kui Sun²Tianyao Wang²Yonghui Yang^2*Sanbing Wu^2*

• ¹Department of Emergency, Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
• ²Department of Orthopedics and Traumatology, Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China

Patients with end-stage hemophilia often require total knee arthroplasty (TKA); however, the incidence of postoperative joint adhesions in these patients is significantly higher than that in the general population. Furthermore, due to their impaired coagulation function, the bleeding risk associated with traditional open adhesiolysis is also higher in this patient cohort than in the general population, and conservative rehabilitation therapy yields suboptimal outcomes. Thus, there is an urgent clinical need for a safe and effective intervention regimen. This study reports a 25-year-old male patient with severe hemophilia A (factor Ⅷdeficiency), whose baseline factor Ⅷactivity was 0.8%. Severe knee joint adhesions occurred 3 months after TKA, manifested as difficulty in walking, sitting, and standing. A combined treatment regimen of "perioperative precise coagulation factor replacement + ultrasound-guided acupotomy release under anesthesia + graded manual release" was adopted for the intervention of post-TKA adhesions in patients with severe hemophilia A. The results showed that this combined regimen may represent a feasible minimally invasive option for the clinical management of post-TKA adhesions in severe hemophilia A patients.