Surgical management of haemophilia-associated ankle arthropathy: open and arthroscopic ankle arthrodesis outcomes

F. Wong, A. Fahy, B. Rose, J. Taylor, S. Austin, D. Back

Introduction: Arthroscopic ankle arthrodesis has been shown in non-haemophiliac patients to provide similar or superior rates of fusion to open ankle fusion. However, the literature regarding ankle arthrodesis in patients with haemophilia is markedly limited. The aim of this study was to compare the rate of successful fusion between open and arthroscopic approach in patients with haemophilic arthropathy of the ankle and subtalar joints performed at a single orthopaedic unit supported by the regional haemophilia centre.

Methods: Retrospective analysis of all patients with haemophilia who underwent ankle arthrodesis at our tertiary referral centre was undertaken. Information on patient demographics, type and severity of haemophilia, surgical approach, surgical outcomes including peri- and post-operative complications were extracted from paper chart review and electronic patient records. The rate of successful arthrodesis was determined from radiographs.

Results: We identified 12 cases of surgical fusion for haemophilia-associated ankle arthropathy from a regional haemophilia centre and performed by a single orthopaedic unit. The mean age at the time of primary fusion procedure was 42 years (range 23-62). There were 8 patients with severe haemophilia of which 7 were of Type A. There were 4 cases of primary arthroscopic fusion and 7 primary open procedures, with a mean follow-up period of 9.2 years. The success rates of arthroscopic and open tibiotalar arthrodesis were 100% and 85.7% respectively. There were 3 reported complications following open procedures, including revision arthrodesis, wound haematoma, and a superficial wound infection. In the arthroscopic group, one patient had surgical resection of a painful tibiofibular pseudoarthrosis.

Conclusions: Our study demonstrates that arthroscopic ankle fusion for haemophilia-associated arthropathy has a rate of successful fusion comparable to open procedure, albeit in a limited patient group. The results were also comparable with the reported rate of success in the literature for non-haemophiliac patients undergoing similar procedures.