Ankle arthrodesis and total ankle replacement in patients with congenital bleeding disorders suffering from severe ankle arthropathy

ABSTRACT

Introduction

In patients with congenital bleeding disorders suffering from severe ankle arthropathy, when conservative treatment and joint-preserving surgical techniques fail, there are two possible non-joint-preserving options: ankle arthrodesis (AA) and total ankle replacement (TAR)

Areas covered

The scope and aim of this article was to analyze the current role of AA and TAR in patients with congenital bleeding disorders suffering from severe ankle arthropathy.

Expert opinion

In patients with congenital bleeding disorders, both TAR and AA provide good results, mainly in terms of pain relief, although they are not exempt from complications (between 0% and 33% in TAR and between 5% and 23.5% in AA). The current controversy about which of the two surgical techniques, TAR or AA, gives better results, the current literature is not able to resolve it in patients with congenital bleeding disorders. While this question is being answered, my opinion regarding patients with congenital bleeding disorders is that the age of the patient must be taken into account. Given known prosthetic survival rates, the older the patient, the more we might be inclined to indicate TAR. Conversely, AA may be more appropriate for relatively young patients.

KEYWORDS:

• Congenital bleeding disorders
• hemophilia
• von Willebrand disease
• ankle arthropathy
• ankle arthrodesis
• total ankle replacement
• results
• complications

Article highlights

• Management of hemophilic ankle arthropathy is commonly initially conservative, based on hematological prophylaxis, analgesics, antiinflammatory drugs (COXIBS), Physical and Rehabilitation Medicine, and intraarticular injections of various drugs (corticosteroids, hyaluronic acid).

• In case of severe synovitis causing recurrent ankle hemarthrosis, a synovectomy, either chemical, isotopic or arthroscopic, may also be indicated.

• When despite conservative treatment the pain becomes unbearable and the functional capacity of the ankle seriously affected, it will be required to think about making a surgical indication.

• There are surgical procedures that preserve the joint, but whose outcomes are temporary and variable. These include resection of an anterior osteophyte of the distal tibia, arthrodiastasis, and arthroscopic debridement.

• When joint-preserving surgical techniques also fail, there are two possible non-joint-preserving options: ankle arthrodesis (AA) and total ankle replacement (TAR).

• Several publications in hemophilia have reported good results with both techniques (AA and TAR), although they are not free from complications (between 0% and 33% in TAR and between 5% and 23.5% in AA).

• The current controversy about which of the two surgical techniques, TAR or AA, gives better results, the current literature is not able to resolve it in patients with congenital bleeding disorders.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.