Total ankle replacement in patients with haemophilia and virus infections – a safe alternative to ankle arthrodesis?

Abstract

Despite reliable results of ankle fusion for advanced haemophilic arthropathy, total ankle replacement (TAR) may be functionally advantageous. There is only very limited literature data available on TAR in patients with haemophilia. The objective of this study is to evaluate the short- and mid-term results after TAR in patients with end-stage haemophilic ankle arthropathy and concomitant virus infections. In a retrospective study, results after eleven TAR in 10 patients with severe (n = 8) and moderate (n = 2) haemophilia (mean age: 49 ± 7 years, range, 37-59) were evaluated at a mean follow-up of 3.0 years (range, 1.2-5.4). Nine patients were positive for hepatitis C, five were HIV-positive. Range of motion (ROM), AOFAS-hindfoot-score, pain status (visual analogue scale, VAS) as well as patient satisfaction were evaluated. In two cases deep prosthesis infection occurred leading to the removal of the implant. In the remaining eight patients the mean AOFAS score improved significantly from 21.5 to 68.0 points (P < 0.0005), the VAS score decreased significantly from 7.6 to 1.9 points (P < 0.0005). ROM increased from 23.2 to 25.0 degrees (P = 0.51). At final follow-up all patients without any complications were satisfied with the postoperative results. Radiographic examination did not reveal any signs of prosthetic loosening. TAR is a viable surgical treatment option in patients with end-stage ankle osteoarthritis due to haemophilia. It provides significant pain relieve and high patient satisfaction. However, due to the increased risk of infection and lack of long-term results, TAR particularly in patients with severe haemophilia and virus infections should be indicated carefully.

Hindfoot fusion in haemophilic arthropathy: 6‐year mean follow‐up of 41 procedures performed in 28 adult patients

“…A recent article has identified five studies , which analysed the short and mid‐term follow‐up of TAR in haemophilic patients. These studies totalled 33 TARs in 28 haemophilia patients and showed good rates of pain relief and patient satisfaction.…”

Surgical procedures in patients with haemophilic arthropathy of the ankle

“…In patients without prosthesis failure, there were no radiographic signs for prosthesis loosening or subsidence. The adjacent joint status remained comparable to the preoperative status [80]. Recently, Kotela et al [72] published a case series of three patients with bleeding disorders treated by TAR using a three-component prosthesis.…”

“…All available clinical studies reporting TAR outcomes in patients with bleeding disorders have demonstrated significant pain relief [65][66][67][68][69][70][71][72][76][77][78]80,81]. Most studies reported improved functionality, including increased ankle range of motion, postoperatively [65][66][67][68]72,75,76,79,80,82]. However, the observed increase in range of motion was overall very low with an average of <10° (Table 3).…”

Perioperative management and outcome of fracture treatment in patients with haemophilia without inhibitors

“…This is remarkable despite the high rate of PWH with a severe form of the disease (45.7%) and concomitant viral infections (50%). In elective joint replacement surgery, the complication rate has been reported to be significantly higher than in the normal population [18]. However, the two observed refractures after minor traumas of the distal radius might be due to the higher prevalence of osteoporosis in PWH [19,20].…”