Clinical and patient reported outcome of total ankle replacement compared to ankle fusion in end-stage heamophilic arthropathy

Objectives Ankle arthropathy is a frequent complication of haemophilia, reducing patient quality of life. Despite intensive conservative therapy, end-stage arthropathy requires surgical treatment, either by ankle fusion or total ankle replacement. The present study compares short- and midterm outcomes of both operations in patients who were treated at two Haemophilia Comprehensive Care Centers.

Methods Eleven consecutive ankle fusions were performed in nine patients and eleven total ankle replacements in ten patients. The mean ages of the patients in these groups were 35.7 years and 49.4 years, respectively. Outcomes were assessed clinically by AOFAS score and radiologically by the Pettersson and Gilbert scores.

Results and Conclusion Of the eleven ankles that underwent fusion, ten showed bony consolidation not later than twelve weeks, whereas one showed non-union after six months. VAS pain scores decreased significantly in both groups: from 7.4 to 0.7 in the fusion group and from 7.6 to 1.9 in the total replacement group. Mean AOFAS scores also improved significantly, from 28.1 before to 80.3 (p = 0.002) after ankle fusion and from 21.5 before to 68.0 (p = 0.018) after ankle replacement. No perioperative complications were observed in either group. Deep infection was observed in two ankles that underwent total ankle replacement, which required removal of the implant.

Conclusion: Ankle fusion and total ankle replacement in patients with end-stage haemophilic arthropathy both result in high patient satisfaction. Fewer perioperative complications, especially deep infections, and lower pain scores suggest that ankle fusion is preferable in young patients with haemophilic arthropathy. Both methods reduced pain and improved quality of life in patients with haemophilia.

Stichwörter Haemophila, Haemophilic Arthropathy, Ankle Fusion, Total Ankle Replacement

Publication History

Article published online:
15 October 2020