Arthroscopic ankle fusion is a viable option to treat arthropathy caused by hemophilia, according to a new study published in The Foot.
First author Nemandra Sandiford and the coauthors of the study reported the rate of successful fusion to be comparable to that of open procedures. They wrote, “Despite the small patient population, our results, together with existing evidence in the literature, indicate that arthroscopic arthrodesis provides potential advantages in management to the hemophilia population.”
Ankle arthropathy is a common complication in patients with hemophilia. However, the management of the condition in this patient group remains challenging.
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Even though arthroscopic ankle fusion has been shown to be similar to or better than open ankle surgery in terms of fusion rates in the general population, little is known about its efficacy in patients with hemophilia.
Here, a team of researchers from Guy’s and St Thomas’ Hospital NHS Foundation Trust in London, England conducted a retrospective study to ”compare the rate of successful fusion between open and arthroscopic-assisted arthrodesis” in patients with hemophilia.
Of 17 arthrodesis procedures that were performed in 13 hemophilia patients (10 with hemophilia A and 3 with hemophilia B), 9 were arthroscopic and 8 were open. The success rate of arthroscopic arthrodesis was 100%, while that of open tibiotalar arthrodesis was 87.5%.
In total, there were 4 complications. One of these was a nonunion that occurred in the open procedure group. A subsequent hematoma occurred in the same patient following revision surgery. Another patient in the open procedure group had a superficial wound infection, which resolved with antibiotic treatment. In the arthroscopic group, 1 patient had a pseudoarthrosis of the distal tibiofibular joint; this complication required a revision procedure.
Arthropathy is thought to be caused by recurrent bleeding in patients with hemophilia, leading to cartilage degeneration. The treatment of arthropathy in these patients includes analgesia, physiotherapy, and surgery such as radiosynovectomy, arthroscopic or open debridement, arthrodesis, and arthroplasty.
Sandiford N, Wong F, Back D, Chan O. Ankle arthrodesis in patients with haemophilia-associated ankle arthropathy – does the technique influence the outcome? Foot. Published online January 25, 2022. doi:10.1016/j.foot.2022.101908