Clinical and patient reported outcome in total ankle replacement compared to ankle fusion in end-stage haemophilic arthropathy.
ankle fusion
haemophilia
haemophilic arthropathy
surgery
total ankle replacement
Journal
Haemophilia : the official journal of the World Federation of Hemophilia
ISSN: 1365-2516
Titre abrégé: Haemophilia
Pays: England
ID NLM: 9442916
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
revised:
14
09
2021
received:
20
04
2021
accepted:
22
09
2021
pubmed:
9
10
2021
medline:
11
11
2021
entrez:
8
10
2021
Statut:
ppublish
Résumé
Ankle arthropathy is a frequent complication of haemophilia, reducing the patients' quality of life. Despite intensive conservative therapy, end-stage arthropathy requires surgical treatment, either by ankle fusion (AF) or total ankle replacement (TAR). Eleven consecutive AFs were performed in nine patients and 11 TARs were implemented in 10 patients. Outcomes were assessed clinically by AOFAS score and radiologically by the Pettersson and Gilbert scores. The mean age of the patients in these groups were 35.7 years and 49.4 years, respectively. Of the 11 ankles that underwent fusion, 10 showed bony consolidation not later than 12 weeks after surgery, whereas one still showed non-union after 6 months. VAS pain scores decreased significantly in both groups. Mean AOFAS scores also improved significantly, from 28.1 before to 80.3 after AF and from 21.5 before to 68.0 after ankle replacement. No perioperative complications were observed in either group. Late deep infection was observed in two patients that underwent TAR, which required removal of the implant. Our data indicate that both AF and TAR result in significantly reduced pain in patients with haemophilia with end-stage haemophilic arthropathy. While TAR is associated with a higher risk of deep infection and minimal persistent pain, it preserves the pre-operative range of motion. AF on the other hand is associated with the risk of non-union and a longer post-operative recovery period but results in greater pain reduction.
Sections du résumé
BACKGROUND
BACKGROUND
Ankle arthropathy is a frequent complication of haemophilia, reducing the patients' quality of life. Despite intensive conservative therapy, end-stage arthropathy requires surgical treatment, either by ankle fusion (AF) or total ankle replacement (TAR).
METHODS
METHODS
Eleven consecutive AFs were performed in nine patients and 11 TARs were implemented in 10 patients. Outcomes were assessed clinically by AOFAS score and radiologically by the Pettersson and Gilbert scores.
RESULTS
RESULTS
The mean age of the patients in these groups were 35.7 years and 49.4 years, respectively. Of the 11 ankles that underwent fusion, 10 showed bony consolidation not later than 12 weeks after surgery, whereas one still showed non-union after 6 months. VAS pain scores decreased significantly in both groups. Mean AOFAS scores also improved significantly, from 28.1 before to 80.3 after AF and from 21.5 before to 68.0 after ankle replacement. No perioperative complications were observed in either group. Late deep infection was observed in two patients that underwent TAR, which required removal of the implant.
CONCLUSION
CONCLUSIONS
Our data indicate that both AF and TAR result in significantly reduced pain in patients with haemophilia with end-stage haemophilic arthropathy. While TAR is associated with a higher risk of deep infection and minimal persistent pain, it preserves the pre-operative range of motion. AF on the other hand is associated with the risk of non-union and a longer post-operative recovery period but results in greater pain reduction.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e739-e746Informations de copyright
© 2021 The Authors. Haemophilia published by John Wiley & Sons Ltd.
Références
Wallny T, Hess L, Seuser A, et al. Pain status of patients with severe haemophilic arthropathy. Haemophilia. 2001;7:453-458.
Rodriguez-Merchan EC. The haemophilic ankle. Haemophilia. 2006;12:337-344.
Rodriguez-Merchan EC. Management of hemophilic arthropathy of the ankle. Cardiovasc Hematol Disord Drug Targets. 2017;17:111-118.
Eckers F, Bauer DE, Hingsammer A, et al. Mid- to long-term results of total ankle replacement in patients with haemophilic arthropathy: a 10-year follow-up. Haemophilia. 2018;24:307-315.
Strauss AC, Goldmann G, Wessling M, et al. Total ankle replacement in patients with haemophilia and virus infections-a safe alternative to ankle arthrodesis? Haemophilia. 2014;20:702-708.
Jordan RW, Chahal GS, Chapman A. Is end-stage ankle arthrosis best managed with total ankle replacement or arthrodesis? A systematic review. Adv Orthop. 2014;2014:986285.
Sackstein P, Cooper P, Kessler C. The role of total ankle replacement in patients with haemophilia and end-stage ankle arthropathy: a review. Haemophilia. 2021;27:184-191.
Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349-353.
Pettersson H, Ahlberg A, Nilsson IM. A radiologic classification of hemophilic arthropathy. Clin Orthop Relat Res. 1980:149:153-159.
Gilbert MS. Prophylaxis: musculoskeletal evaluation. Semin Hematol. 1993;30:3-6.
Lawton CD, Butler BA, Dekker RG, 2nd, et al. Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. J Orthop Surg Res. 2017;12:76.
Bluth BE, Fong YJ, Houman JJ, et al. Ankle fusion in patients with haemophilia. Haemophilia. 2013;19:432-437.
Brkljac M, Shah S, Hay C, et al. Hindfoot fusion in haemophilic arthropathy: 6-year mean follow-up of 41 procedures performed in 28 adult patients. Haemophilia. 2016;22:e87-e98.
Eichler D, Ehlinger M, D'Ambrosio A, et al. Ankle fusion in hemophilic patients. Orthop Traumatol Surg Res. 2017;103:1205-1209.
Braito M, Dammerer D, Kaufmann G, et al. Are our expectations bigger than the results we achieve? a comparative study analysing potential advantages of ankle arthroplasty over arthrodesis. Int Orthop. 2014;38:1647-1653.
Barg A, Barg K, Wiewiorski M, et al. Total ankle replacement in patients with bleeding disorders. Orthopade. 2015;44:623-638.
Barg A, Zwicky L, Knupp M, et al. HINTEGRA total ankle replacement: survivorship analysis in 684 patients. J Bone Joint Surg Am. 2013;95:1175-1183.
Lewis JS, Jr., Green CL, Adams SB, Jr., et al. Comparison of first- and second-generation fixed-bearing total ankle arthroplasty using a modular intramedullary tibial component. Foot Ankle Int. 2015;36:881-890.
Chalayon O, Wang B, Blankenhorn B, et al. Factors affecting the outcomes of uncomplicated primary open ankle arthrodesis. Foot Ankle Int. 2015;36:1170-1179.
Muckley T, Hofmann G, Buhren V. Tibiotalar arthrodesis with the tibial compression nail. Eur J Trauma Emerg Surg. 2007;33:202-213.
Barg A, Elsner A, Hefti D, et al. Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series. Haemophilia. 2010;16:647-655.
Preis M, Bailey T, Jacxsens M, et al. Total ankle replacement in patients with haemophilic arthropathy: primary arthroplasty and conversion of painful ankle arthrodesis to arthroplasty. Haemophilia. 2017;23:e301-e309.
Kessler B, Sendi P, Graber P, et al. Risk factors for periprosthetic ankle joint infection: a case-control study. J Bone Joint Surg Am. 2012;94:1871-1876.
Panotopoulos J, Hanslik-Schnabel B, Wanivenhaus A, et al. Outcome of surgical concepts in haemophilic arthropathy of the hindfoot. Haemophilia. 2005;11:468-471.
Tsailas PG, Wiedel JD. Arthrodesis of the ankle and subtalar joints in patients with haemophilic arthropathy. Haemophilia. 2010;16:822-831.
Asencio JG, Leonardi C, Biron-Andreani C, et al. Short-term and mid-term outcome of total ankle replacement in haemophilic patients. Foot Ankle Surg. 2014;20:285-292.
Saltzman CL, Mann RA, Ahrens JE, et al. Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int. 2009;30:579-596.
Stavrakis AI, SooHoo NF. Trends in complication rates following ankle arthrodesis and total ankle replacement. J Bone Joint Surg Am. 2016;98:1453-1458.
SooHoo NF, Zingmond DS, Ko CY. Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty. J Bone Joint Surg Am. 2007;89:2143-2149.
Coester LM, Saltzman CL, Leupold J, et al. Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am. 2001;83:219-228.
Labek G, Todorov S, Iovanescu L, et al. Outcome after total ankle arthroplasty-results and findings from worldwide arthroplasty registers. Int Orthop. 2013;37:1677-1682.
Fevang BT, Lie SA, Havelin LI, et al. 257 ankle arthroplasties performed in Norway between 1994 and 2005. Acta Orthop. 2007;78:575-583.
Hopgood P, Kumar R, Wood PL. Ankle arthrodesis for failed total ankle replacement. J Bone Joint Surg Br. 2006;88:1032-1038.