Anterior osteophyte resection of the ankle joint to increase range of motion in haemophilic ankle arthropathy

Abstract

Introduction Haemophilic ankle arthropathy may cause joint bleeding, pain, stiffness, erosion and progressive motion limitations, including a decreased range of motion (ROM) secondary to anterior osteophyte impingement. Aim The purpose of this study was to investigate changes in the ROM and symptoms after synovectomy and anterior osteophyte resection for haemophilic ankle arthropathy. Methods We retrospectively reviewed 41 ankles in 35 patients with haemophilic arthropathy who underwent arthroscopic and/or open synovectomy. The mean follow‐up period was 59.5 months. Indications for the procedure included a lack of improvement with conservative management, and the presence of haemarthrosis and arthralgia. We assessed radiographic images, ankle joint range of motion, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle‐Hindfoot score and patients’ subjective satisfaction preoperatively and at the last follow‐up. Results Arthroscopic synovectomy was performed in 32 ankles, open synovectomy in 6, and arthroscopic synovectomy with additional mini‐open debridement in 3. Ankle dorsiflexion improved from a mean of 2.7° preoperatively to a mean of 7.5° at the final follow‐up (P = 0.003), whereas plantar flexion improved from a mean of 30.7° preoperatively to a mean of 32.7° at the final follow‐up (P = 0.276). The AOFAS score improved from 62.2 preoperatively to 79.1 at the final follow‐up (P < 0.001). Patient satisfaction was “excellent” in 11 ankles, “good” in 22, “fair” in 3 and “poor” in 5. Conclusion Arthroscopic and/or open synovectomy with anterior osteophyte resection and early rehabilitation in adolescents and adults with haemophilic ankle arthropathy showed improved ankle dorsiflexion and AOFAS scores.

Comparison of Total Ankle Arthroplasty and Ankle Arthrodesis in End-Stage Hemophilic Arthropathy

“…26 In hemophilic ankle arthropathy, arthroscopic and/or open synovectomy, osteophyte resection, or corrective osteotomy may be considered depending on initial symptoms. 24,40 However, in recalcitrant ESHAA, more invasive surgery such as distractive arthroplasty, AA, or TAA may be required. 4,5,7,[33][34][35] To date, the standard treatment is AA, 3 but the scientific evidence for this is poor compared to that for nonhemophilic ankle arthritis.…”

Arthroscopic ankle surgery in people with haemophilia

“…All four published series on arthroscopic ankle debridement reported good outcomes [40][41][42][43] (Table 3). However, four patients (4/88, 4.5%)…”

“…In other words, complications occurred in seven (7.9%) of the 88 arthroscopic ankle debridement procedures reported in the four series that quantified them. [40][41][42][43] Table 3 summarises the primary outcomes and complications of the case series published in the literature on arthroscopic debridement of the ankle in PWH. [40][41][42][43]…”

“…[40][41][42][43] Table 3 summarises the primary outcomes and complications of the case series published in the literature on arthroscopic debridement of the ankle in PWH. [40][41][42][43]…”

Changes in Muscle Activity Patterns and Joint Kinematics During Gait in Hemophilic Arthropathy

“…The decreased dorsi-flexion in PWHA may be explained by articular and non-articular factors. Different surgical approaches improve dorsi-flexion (i.e., increased passive ROM) in PWHA, such as the release of the posterior joint capsule (Barg et al, 2016), the anterior osteophyte on the tibiotalar joint (Yoo et al, 2019), and Achilles tendon lengthening (Ribbans and Rees, 1999).…”