Ankle arthrodesis performed in patients with hemophilic ankle arthropathy may improve pain and functioning while keeping revision and complication rates low, according to a study published in Haemophilia. 

The authors conducted a literature review to investigate the mid- to long-term postoperative outcomes of ankle joint fusion in patients with hemophilia. They sought to understand the impact of this procedure on various parameters of healing and take patient-reported outcomes into account.

The team accepted academic studies involving patients with hemophilia A or B who had an ankle fusion procedure (regardless of technique). They required at least 1 year of postoperative follow-up data. They also accepted detailed case reports, expert opinions, and review articles. 

Continue Reading

The team included 17 studies in their final analysis. The studies reported fusion rates of 90.3% to 100%, while the time to union across 6 studies ranged from 2 to 4 months. Despite a variety of postoperative complications (such as pin tract infection, superficial wound infection, and tibial osteomyelitis), none resulted in postoperative mortality. Out of 170 ankle fusions across 14 studies, only 11 revision surgeries were recorded. 

Read more about hemophilia etiology 

In regard to patient-reported outcomes, in 3 studies that utilized the visual analog scale pain score (in which 36 patients took part), the mean preoperative score was 6.3, and the mean postoperative score was 0.9. 

“Ankle fusion in hemophilia is a safe procedure that improves the quality of life for patients when planned effectively with patient optimization and perioperative care, within multidisciplinary, specialized centers,” the authors of the study concluded. Their goal was to produce work that may help enhance the perioperative care of patients undergoing hemophilic ankle arthropathy. 

In hemophilia, knee and elbow joints are among the sites most commonly affected by hemarthrosis. However, recent studies point to the increasing involvement of the ankle joints; some studies indicate it has become the primary joint affected in hemophilia, affecting up to 41% of individuals. 

Hemorrhage into joints triggers an inflammatory cascade that results in cartilage damage. Increased osteoclast activity and subchondral bone resorption contribute to joint destruction, deformity, and pain. In advanced cases, clinicians usually recommend ankle arthrodesis and total ankle replacement as surgical options to relieve symptoms associated with ankle arthropathy. 


Anazor FC, Uthraraj N, Southgate C, Dhinsa B. Mid-to long-term postoperative outcomes of ankle joint fusion in patients with haemophilia: a systematic reviewHaemophilia. Published online March 8, 2023. doi:10.1111/hae.14770