Arthrodesis of the ankle and subtalar joints in patients with haemophilic arthropathy

Abstract

There have been only a few studies in the literature that reported on the outcome of ankle arthrodesis in patients with haemophilia; furthermore, the number of patients was usually low and the operative technique has not been uniform. The aim of this study was to evaluate the outcome of surgery in haemophilic arthropathy of the ankle and subtalar joints, using internal fixation. From 1983 to 2006, 20 fusions were performed in 13 patients with advanced haemophilic arthropathy of the ankle and subtalar joints. There were 11 ankle fusions, one isolated subtalar fusion and eight combined ankle and subtalar fusions. Three of the latter had a subtalar fusion at a second operation. The mean age at operation was 38.7 years and the mean followup was 9.4 years. In the majority of the cases, the ankle fusion was achieved by two crossing screws. For the subtalar fusion, either staples were used or the tibiotalar screws were extended to the calcaneus. Arthrodesis of the ankle was successful in all but one patient, in whose case the procedure was revised and eventually his condition was progressed to fusion. There was also one case of painless non-union of the subtalar joint which was not revised. There was no recurrent bleeding, and no deep infection. Arthrodesis with cross screw fixation is an effective method for fusion of the ankle and subtalar joints in patients with haemophilia.

Long-term safety and efficacy of emicizumab in a phase 1/2 study in patients with hemophilia A with or without inhibitors

“…1 More than half the population of patients with hemophilia A have severe disease characterized by FVIII activity ,0.01 IU/mL. 2 These patients often experience frequent traumatic or spontaneous bleeding events, 2 including joint bleeding, 3 which leads to irreversible hemophilic arthropathy, the major cause of morbidity and reduced quality of life in patients with hemophilia.…”

Functional outcomes following ankle arthrodesis in males with haemophilia: analyses using the CDC's Universal Data Collection surveillance project

“…Though this study reports relatively short-term outcomes, the results may provide reassurance to PWH who are reluctant to undergo this procedure. Though pain was not included as an outcome in the UDC, previous studies [8,9] strongly support the efficacy of AA in reducing pain. It is likely that pain was also reduced in this cohort.…”

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

“…Včasih je po dogovoru z ortopedom, ki ima izkušnje z zdravljenjem zapletov na kosteh in sklepih pri osebah s hemofilijo, potrebna rekonstruktivna kirurgija. Vključuje vstavitev umetnih sklepov (endoproteza), da se izboljšajo funkcijske sposobnosti ali pa se reši vprašanje zelo močnih bolečin v enem sklepu (162)(163)(164)(165)(166). Ustrezno kratkotrajno ali daljše terciarno profilaktič-no zdravljenje te postopke omogoča in preprečuje slabšanje stanja.…”