Effectiveness of ankle fusion in patients with hemophilia, advanced ankle degeneration, and unbearable pain for whom nonsurgical and surgical treatments have been ineffective
Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain. Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain.
INTRODUCTION In underdeveloped countries, patients with hemophilia often experience repetitive ankle joint hemorrhages due to a shortage of coagulation factors (factor VIII [FVIII] and factor IX [FIX] for hemophilia A and B, respectively). AREAS COVERED This is a narrative literature review in which we searched the Cochrane Library and MEDLINE for articles related to ankle arthrodesis in patients with hemophilia.
The searches covered the period from the databases´ inception to February 28, 2021. In the event of unsuccessful hematologic prophylaxis and conservative measures (e.g., analgesics, cyclooxygenase-2 inhibitors, taping, intra-articular injections of hyaluronic acid and corticosteroids, physical and rehabilitation medicine, orthoses, radiosynovectomy, and joint-preserving surgery (e.g., removal of the distal tibia by open surgery or by arthroscopic surgery, joint debridement by arthroscopic surgery), the only surgical solution is ankle arthrodesis, which does not preserve the ankle joint. EXPERT OPINION Ankle pain is reduced after ankle arthrodesis (75% of patients experience no pain). Approximately 5% of patients require reoperation due to lack of fusion, and deep infection occurs in 2.5%. After tibiotalar fusion, a self-reported activity scale shows that approximately 12% of patients improve, 9% worsen, and 79% show no improvement. The results of ankle arthrodesis therefore appear to be poor.
