JSM Foot and Ankle

Total Knee Arthroplasty in Hemophilic Patients

Review Article | Open Access | Volume 4 | Issue 1

  • 1. Department of Orthopaedic and Trauma Surgery, ASL BARI, Italy
+ Show More - Show Less
Corresponding Authors
Bernardino Saccomanni, Department of Orthopaedic and Trauma Surgery, ASL BARI, viale REGINA MARGHERITA, 70022, ALTAMURA (BARI), Italy, Tel: 3208007854

In severely affected haemophilic patients arthropathy is a common problem which can lead to considerable pain and functional deficit. Surgical management, including total knee arthroplasty, can be undertaken if conservative management fails. A search of literature showed a number of studies describing the use of total knee arthroplasty. The paper reviews the functional outcome of arthroplasty in knee joint, the postoperative and long-term complications. Although complications are commonly described and the surgery is technically demanding, the results suggest that arthropathy, particularly of the knee, can be a valuable option in the management of severe haemophilic arthropathy


Haemophilia; Total knee arthroplasty; Arthropathy


Saccomanni B (2022) Total Knee Arthroplasty in Hemophilic Patients. JSM Foot Ankle 4(1): 1051


It is well known that patients with haemophilia can present with severe joint distruction in adult life as a result of haemophilic arthropathy. It is commonly multiarticular, affecting shoulders, elbows, knees and ankles. Consequently, the haemophilic patient commonly complains of pain and severe functional deficit related to one or severe joints. Conservative management, including analgesia, physiotherapy, orthotics, and advice on joint care may be sufficient to alleviate symptoms in many cases. If these measures fail, then surgery may be considered. This paper will review the use of total knee arthroplasty in patients with haemophilia.


The knee is the target joint in the majority of hemophilic patients [1,2], and end stage arthropathy is often very painful and disabling [3]. The first report of total knee arthroplasty (TKA) in patients with haemophilia date back to the mid-1970s.


Early reports of results of TKA were promising with good pain relief and no complications although limited flexion was noted in one case [5]. However few details of outcome were available, numbers were small and follow-up short [4,5]. In the late 1970s and early 1980s, larger series of TKAs began to be described [6,7], and more formal methods of assessing outcome began to be used. Two studies used the University Hospitals of Cleveland knee rating form [8,9]. Many other studies have used the Hospital for Special Surgery (HSS) knee rating scale to assess outcome. This includes an evolution of pain, function, range of movement, strength and stability [10]. Insall et al. [10], acknowledged that patients with multiple joint involvement may have worse postoperative scores. Despite this, results of reported studies in hemophilic patients are mainly in the good or excellent categories.

Lachiewicz et al. [7], described the results of 24 TKAs implanted in 14 patients. Using the HSS knee rating scales, results were described as excellent in 15 knees, good in six, fair in one, and poor in two.

Kjaersgaard-Andersen et al. [11], reported that 75% of their patients (nine knees) had an excellent result and 25 % (three knees) had a good result using the same scale. This excluded a patient who was HIV- positive and died 3 months after surgery. No deep infections or aseptic loosening occurred. Magone et al. [12], evaluated the results of nine TKAs in seven patients with a mean follow-up of 4.4 years. Five knees were rated as excellent and four had a good result.

One TKA was a revision of a prosthetis inserted 6 years previously which had become loose. Even in cases where not all the all the results were rated as excellent or good, the preoperative pain markledly improved.

While pain relief is almost always achieved postoperatively, occasionally patients had a prolonged recovery with pain that was slow to seattle [14]. However, the range of movement achieved postoperatively is more variable.


In patients with haemophilia, loss of range of movement can be a problem following TkA. Luck and Kasper [3] identified a loss of Rom in patients with two-compartment prosthetes, but an increase in range in three-compartment prosthetes with use of CPM from the fifth day postoperatively and manipulation under anaesthetic (MUA), in selected cases. It was noted that the used of CMP immediately postoperatively appeared to be associated with increased bleeding.

Figgie [9], also noted a lower mean Rom following TKA without patella resurfacing. Others authors identified an increase in range postoperatively. Lachiewicz et al. [7], recordered a mean increase in Rom of 23° with improvements in both flexion and extension. In their early cases manipulation was performed if the patients had not achieved 90° by the third postoperative week. In their latter cases, manipulation was performed as part of a protocol for postoperative management.

Kjaersgaard-Andersen et al. [11], considered manipulation if the knee could not be flexed beyond 70° preoperatively which increased to 83° at follow-up. Goldberg et al. [8], included MUA in the second week in four arthroplasties but as no appreciable increase in motion was obtained, the technique was discarded. The overall arc of movement increased 13° with a particular improvement in the flexion contracture. Karthaus and Novakova [13], identified a mean 20° increase in arc of movement. Eight of the knees were manipulated in the second or third week postoperatively. They concluded, however, that manipulation was inappropriate as it delayed healing, caused pain and required additional factor replacement. They also noted that while marked flexion contractures were not a contra-indication to surgery, the operation may be more difficult and the results less optimal.

In a study of ten patients, McCollough et al. [6], identified variable results in range postoperatively. One knee increased range, six lost movement and three had the same arc of movement as preoperatively. The mean increase in extension was 6.5°, with a loss of flexion of 15°. There was no mention of the use of MUA in the postoperative period.

Wiedel et al. [15], in a multicentre review of 76 patients with 93 TKAs, noted that although the arc of movement only improved marginally, the flexion contracture improved more and the available movement was therefore more functional. Magone [12], also identified an improvement in the flexion deformity. They reported on nine TKAs in seven patients.

There was a mean increase in arc of motion of 30° postoperatively, the flexion deformity mean preoperatively was 21° and this reduced to 8° postoperatively.

Teigland et al. [16], also reported a decrease in flexion contractures postoperatively but a reduction in flexion range, the overall arc of movement being unchanged. Unger et al. [17], reported that the arc of movement was increased in 23 of their 26 TKAs, mean 28°.

Three knees lost range. Thirteen of the joints had manipulation to improve range. Heeg et al. [14], performed MUA due to limited range of motion postoperatively in two patients. RodriguezMerchant and Wiedel [18], in a retrospective study of 37 TKAs identified that an MUA was less often required in those patients who had their TKA after 1986. The authors hypothesized that this may be due to higher levels of factor replacement postoperatively, allowing more active rehabilitation.

Range of movement achieved in the early postoperative period may be maintained in the longer term due to soft tissue changes [19]. Rana et al [20], noted that in one patient with TKA, the range of movement achieved postoperatively was diminished after 6 months with a return of flexion deformities.

Surace and Pietrogrande [21], described a patient with only 20° flexion preoperatively, which increased to 40° postoperatively, but reduced again within 3 months. Manipulation under anaesthetic and exercices restored the range to the immediate postoperative level. In a review of 21 TKA in 16 patients by Cohen et al [19], two patients had developed fibroarthrosis when examined a year after surgery.

MUA restored range to 90° which was maintained. The main improvement identified in the studies was an improvement in flexion contracture associated with a more functional, energysufficient gait. The stage of joint degeneration, soft tissue contractures and type of prosthetis may account for some of the variation in the range of movement achieved postoperatively [11,22]. MUA was performed to increase range of movement in a number of studies [3,7,11,14,17], however, other authors [8,13] considered that it did not change range and may increase pain and delay healing. If carried out, it was usually performed within the first 2-3 weeks postoperatively although MUA even 1 year after surgery was still reported to be beneficial [19].

In cases where there was severe loss of movement, necessitating a tibial tuberosity osteotomy in order to access the joint, manipulation was not appropriate [11]. The technical problems of TKA are considerable and include difficult exposure of the joint, lack of bone stock, deformities, quadriceps contracture, adhesions and soft tissue contractures [7-9]. These factors may influence the range of movement achieved.


Most TKA studies report a number of complications. Preoperative complications secondary to factor replacement included Coomb-positive haemolysis, haemolytic anemiae, development of an inhibitor and anaphylactic reaction. Other complications were related to the operation, such as haemarthroses, haemartoma which required evacuation, low grade infections which settled with intravenous antibiotics and wound breakdown. Other problems also occurred during the postoperative period, including gastro-intestinal bleeding, epixtasis, urinary infection, recurrent phlebitis at the site of venous puncture and fever of unknown cause of a few days duration [3,6,7,11,13-16].

Complications described by Goldberg [8], in a report of 13 TKAs in ten patients were quite extensive and included three cases of postoperative bleeding, one of which was associated with a deep infection that ultimately required arthrodesis. A second patient had recurrent bleeds which resolved following revision of a malaligned tibial component 10 months after the original surgery.

The third case of postoperative bleeding settled without further intervention. There were also five cases of superficial wound infection. Two patients later required a secondary patella resurfacing procedure due to patellofemoral pain. The authors considered that this should be performed as part of the TKA in order to improve the outcome.

In three patients, a posterior tibial and three peroneal nerve palsies occurred postoperatively, which may have been related to the increase in extension postoperatively causing stretching of the neurovascular structures. Other studies have also reported partial peroneal nerve palsies [15]. Figgie et al. [9], in a longer term follow-up of the previous study discussed possible reasons why six of the 19 TKAs were rated as poor or failures.

This included any prosthetic components that were subsequently removed, which were rated as zero. Of seven knees performed under 80% factor replacement under 80% factor replacement cover, four of these failed and six of the seven had complications.

The authors considered that the type of prosthetis used may also have been a factor. Additional complications and further surgical procedures to these described by Goldberg above, included one skin necrosis, one transfusion reaction and four cases of postoperatively bleeding. A further two revisions were performed due to loosening and in one case, removel of a cement spur was required.

The authors also reported a high rate of radiographic lucencies, possibly related to the postoperative bleeding. Luck and Kasper [3], described an extensive review of 20 years experience of orthopaedic surgery including 46 TKAs. Late complications following TKA included one patient with recurrent haemarthroses in the early months, a complication also described by Magone [12]. In other case, deep infection was associated with dental abscess affecting both replaced joints, which responded to antibiotic therapy. Two revisions were also performed for aseptic loosening of the tibia/ femoral components.


Total knee arthroplasty is considered the gold standard for the treatment of the end stage chronic arthropaty in hemophilic patients [24, 25]. Unfortunately, the reported prevalence of infection ranges from 0 to 17%, which is much higher than the prevalence of 1%-2 % observed after THA in the non hemophilic population, and the rate of prosthetic survival is 90% after 5 years [26-28]. Recently, the mean rate of infection was reported as 6,9, ranging from 1.4 to 11,4 % [24]. In order to obtain a decrease of infection rate with similar outcomes to that of total knee arthroplasty in the general population, the maintenance of high level of clotting factor replacement throughout wound healing has been supported [29]. The effectiveness of the use of antibiotic-loaded cement to prevent the onset of infection after primary total knee arthroplasty in patients with haemophilia is still controversial [30].


After revisioning the literature, the results suggest that total knee arthroplasty can relieve pain and improve function in symptomatic haemophilic patients. Arthroplasty is technically demanding due to soft tissue fibrosis, contractures and poor bone quality, and complications can be considerable.

It is important for the patients to have realistic expectations of what surgery can offer [23], and the importance of an experienced multidisciplinary team in the management of haemophilic patient is paramount. Despite improvements in medical treatment, arthroplasty remains a problem for many patients. Furtunately, total knee arthroplasty, is a valuable option which can enable the patient to have a painfree joint and improved quality of life.


1. York J. Muscoloskeletal disorders in the haemophilias. Bailliere’s Clin Rheumatol. 1991; 5: 197-220.

2. Rodriguez-Merchan EC. Effects of haemophilia on articulations of children and adults. Clin Orthop. 1996; 328: 7-13.

3. Luck J, Kasper C. Surgical management of advanced hemophilic arthroplasty. Clin Orthop. 1989; 242: 60-82.

4. Post M, Telfer M. Surgery in hemophilic patients. J Bone Joint Surg. 1975; 57A: 1136-1145.

5. Marmor L. Total knee replacement in haemophilia. Clin Orthop. 1977; 125: 192-195.

6. Mc Collough N, Enis J, Lovit J, Lian E, Niemann K, Loughlin E. Sinoviectomy or total replacement of the knee in haemophilia. J Bone Joint Surg. 1979; 61A: 69-75.

7. Lachiewicz PF, Inglis AE, Insall JN, Sculco TP, Hilgartner MW, Bussel JB. Total knee arthroplasty in hemophilia. J Bone J Surg. 1985; 67A: 1361-1366.

8. Goldberg V, Heiple K, Ratnoff O, Kurczynsky E, Arvan G. Total knee arthroplasty in classic hemophilia. J Bone Joint Surg. 1981; 63A: 695- 701.

9. Figgie M, Goldberg V, Figgie H, Heiple K, Sobel M. Total knee arthroplasty for the treatment of cronic hemophilic arthroplasty. Clin Orthop. 1989; 248: 98-107.

10.Insall J, Ranawat C, Aglietti P, Shine J. A comparison of four models of total knee-replacement prosthetes. Am J Bone J Surg Am. 1976; 6: 754-765.

11.Kjaersgaard-Andersen P, Christiansen S, Ingerslev J, Sneppen O. Total knee arthroplasty in cronic hemophilic arthropathy. Clin Orthop. 1990; 256: 137-145.

12.Magone J, Dennis D, Weis L. Total knee arthroplasty in chronic hemophilic arthroplasty. Orthopaedics. 1986; 9: 653-657.

13.Karthaus R, Novakova I. Total Knee replacement in haemophilic arthropathy. J Bone J Surgery. 1988; 3: 382-385.

14.Heeg M, Meyer K, Smid W, Van Horn J, Van der Meer J. Total knee arthroplasty in the patient with hemophilia. Haemophilia. 1998; 4: 747-751.

15.Wiedel JD, Luck JV, Gilbert MS. Total knee arthroplasty in the patient with haemophilia: evualution and long-term results. In: Gilbert MS, Greene WB eds. Musculoskeletal Problems in Haemophilic National Hemophilia Foundation: New York. 1989; 152-157.

16.Teigland J, Tjonnfjord G, Evensen S, Charania B. Knee arthroplasty in hemophilia. Acta Orthop Scand. 1993; 64: 153-156.

17.Unger A, Kessler C, Lewis R. Total knee arthroplasty in human immunodeficiency virus-infected hemophililiacs. J Arthroplasty. 1995; 10: 448-452.

18.Rodriguez-Marchan EC, Wiedel JD. Total Knee Arthroplasty in the HIVpositive patient. Haemophilia Forum, March 20th. 2000.

19.Cohen I, Heim M, Martinowitz U, Chechick A. Orthopaedics outcome of total knee replacement in Haemophilia. 2000; 6: 104-109.

20.Rana N, Shapiro G, Green D. Long term follow-up of prosthetic joint replacement in hemophilia. Am J Haematology. 1986; 23: 329-337.

21.Surace A, Pietrogrande V. Total replacement of knee and elbow in hemophilia: three cases. Int Surg. 1983; 68: 85-88.

22.Johnson R, Babbit D. Five stages of joint disintegration compared with range of motion in haemophilia. Clin Orthop. 1985; 201: 36-42.

23.Miller R, Beeton K, Goldman E, Ribbans W. Counselling guidelines for management muscoloskeletal problems in haemophilia in the 1990s. Hemophilia. 1997; 3: 9-13.

24.Solimeno LP, Mancuso ME, Pasta G, Santagostino E, Perfetto S, Mannucci PM. Factors influencing the long term outcome total knee replacement in haemophiliacs: a review of 116procedures at a single institution. Br J Haematol. 2009; 145: 227-234.

25.Rodriquez Merchan EC. Total knee arthroplasty in hemophilic arthropathy. Am J Orthop. 2015; 44: 503-507.

26.Rodriguez – Merchant EC. Total knee replacement in haemophilic arthropathy. J Bone Surg. 2007; 89b: 186-189.

27.Rodriguez- Marchant EC. Special features of total knee replacement in haemophilia. Expert Rev Hematol. 2013; 6: 637-642.

28.Rodriguez- Marchant EC. Infection after total knee arthroplasty in haemophilic arthropathy with special emphasis on late infection. Haemophilia. 2011; 17: 831-832.

29.Wong JML, Mann HA, Goddard NJ. Perioperative clotting factor replacement and infection in total knee arthroplasty. Haemophilia. 2012: 607-612.

30.Rodriguez- Marchant EC. Preventing surgical site infection in haemophilia patients undergoing total knee arthroplasty. Blood Coagul Fibrinolysis. 2012; 23:477-481.

Saccomanni B (2022) Total Knee Arthroplasty in Hemophilic Patients. JSM Foot Ankle 4(1): 1051.

Received : 14 Feb 2022
Accepted : 05 Mar 2022
Published : 08 Mar 2022
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X