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The purpose of the study was to compare the effectiveness of physiotherapist-supervised and home-based exercises after platelet-rich-plasma (PRP) injection in knee osteoarthritis (OA). Thirty women (mean age = 57.83 ± 7.26 years; mean weight = 72.13 ± 15.54 kg; mean height = 158.40 ± 4.49 cm; mean body mass index = 28.75 ± 6.18 kg/m 2 ) were included. Patients randomized either supervised or home-basedexercise-group after PRP. Both groups performed 6-week (3 times/week) exercise. Pain, hip and knee muscle strength, and knee functions were assessed before and after exercise. The median improvement in the pain from baseline to 6 th week was 3.80 (2.85-5.55) point in-supervised-exercise-group while it was 0.60 (-0.10-2.55) point in home-based-exercise-group (p = 0.002). The median improvement in knee function was 22.91 (13.02-30.20) in supervised-exercise-group overtime (p < 0.001). There was no improvement in knee function following home-based exercises (p = 1.000). The supervised-exercise-group revealed a significant improvement in hip (median difference = 32.00 (8.30-88.95), p = 0.011); quadriceps (median difference = 32.10 (21.65-60.05), p = 0.001) and hamstring (median difference = 27.90 (7.95-37.65), p = 0.022) strength overtime. The physiotherapist-supervised exercises after PRP had better effects on pain and knee function than the home-based exercises.

Background: 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., Method: 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., Results: 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 < 0.01). HSS scores increased from 48.33 preoperatively to 82.67 postoperatively (P < 0.01). There were improvements in both KSS and KSS-F scores from 34.22 and 53.3 preoperatively to 82.00 and 84.63 (P < 0.01), respectively. Ten patients (10 TKAs) (34%) experienced major bleeding during the postoperative period. Six of these patients had moderate hemophilia, and four had severe hemophilia. Three of these patients had hemarthroses (10.2%), one patient had a hematoma (3.4%), one patient had hemorrhagic bullae formation (3.4%), and five had excessive/prolonged bleeding from the wound (17%). The bleeding group (34%) had significantly worse HSS (63.78 vs 92.75, P < 0.001), KSS (61.78 vs 93.25, P < 0.001), and KSS-F (60.71 vs 96.25, P = 0.005) scores compared with controls. Preoperative and postoperative flexion contractures were positively correlated (+0.33, P = 0.003). One of the patients with postoperative hemarthrosis also had an accompanying transient common peroneal nerve palsy, and one patient (3.4%) had a periprosthetic fracture. Three knees (6.6%), two of whom were in the bleeding group, developed periprosthetic infections. Four knees (8.8%) in three patients underwent revision surgery, and two knees (4.4%) ended up in arthrodeses. Kaplan-Meier analysis revealed a mean survival duration of 17.04 years for the bleeding group and 22.15 years for the control group (P = 0.83). Survival rates were 80.0% for the bleeding group and 96.4% for the control group (P = 0.83)., Conclusions: In this study, MPOB after TKA in PWH was common and led to significantly worse function. MPOB after TKA in PWH was associated with a higher rate of complications and lower survival rates, although the differences were not statistically significant. Efforts must be made to avoid MPOB after TKA in PWH., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)