|Beitragstitel||Mid- to Long-Term Results of Total Ankle Replacement in Patients with Hemophilic Arthropathy: a 10-year follow-up|
Introduction: Hemophilic arthropathy is caused by recurrent spontaneous hemorrhaging into so-called target joints. The ankle is one of the most commonly affected sites. Symptoms comprise joint pain and deformity paired with loss of function. Current literature still refers to arthrodesis as the procedure of choice for treatment of advanced articular destruction. Recently, total ankle replacement (TAR) has gained acceptance as an alternative. The objective of this study was, to investigate the mid- to long-term results after TAR in patients with hemophilic ankle arthropathy.
Materials and Methods: Between 1998 and 2012 17 TARs were implanted into 14 male patients (3 x bilateral). 3 revisions with component removal were performed. 2 patients were lost to follow-up. 9 patients with 12 unrevised TARs were available for follow-up exams. Preoperative hemophilic/viral status, additional surgical procedures and intra-/postoperative complications were determined. Implant survival was estimated using Kaplan Meier analysis. The outcome of 12 ankles was assessed using pain and satisfaction scales, the AOFAS hindfoot score, and the SF-36. Pre- and postoperative ROM were statistically compared. Radiographic evaluation of pre- (Pettersson score) and follow-up radiographs was conducted.
Results: 17 ankles received TARs at an average age of 43.4 years (27.4-57.6). The Pettersson score was 7.8 (5-10). With 3 cases revised and 2 lost to follow-up, a total of 12 ankles were seen at 9.6 years (3.3-17.8) postoperatively. The level of satisfaction was rated 76% (50-100), that of pain 2/10 (0-6) on the VAS. ROM had increased significantly (p=0.037). The SF-36 summary scores were not lower than in a sex-/age matched standard population. The AOFAS hindfoot score averaged 81 points (73-90). All follow-up radiographs displayed component loosening or periprosthetic radiolucency. Implant survival based on Kaplan Meier analysis was estimated to be 94% at 5, 84% at 10, and 67% at 15 years.
Conclusion: TAR in the setting of advanced hemophilic arthropathy is a viable treatment option with favorable clinical mid-/long-term results. As opposed to ankle arthrodesis, mobility of the ankle joint is preserved which may be advantageous concerning patient wellbeing. However, implant survival appears to be shorter than in individuals without coagulopathies, while patient age at surgery tends to be younger. The necessity for revision surgery is likely to arise for a majority of these patients.