Ankle fusion in hemophilic patients - 14/11/17

Doi : 10.1016/j.otsr.2017.08.016

D. Eichler ^a, M. Ehlinger ^a,^⁎ , A. D’Ambrosio ^a, D. Desprez ^b, G. Bierry ^c, P. Adam ^a, F. Bonnomet ^a,^b
^a Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
^b Service d’hématologie clinique, centre régional du traitement des hémophiles (CRTH), hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
^c Service de radiologie osseuse, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France

^⁎Corresponding author.

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Abstract

Introduction

Hemophilic arthropathy is painful and disabling. We report a retrospective study of ankle fusion with intra- and peri-operative clotting factor perfusion. The objective was to assess the efficacy of maintaining perioperative clotting factor rates close to 100%, and report long-term results. The study hypothesis was that results would be good, without early hemorrhagic complications.

Material and method

Between 2000 and 2013, 12 ankle fusions were performed in 9 patients, with a mean age of 39years (range, 19–58years). Anti-hemophilic factor perfusion was controlled by the reference physician of the Regional Hemophilia Treatment Center. Clinical AOFAS and Olerud scores and the Pettersson radiologic score were used for assessment. Mean preoperative AOFAS score was 22 (range, 2–55) and mean Olerud score 7 (range, 5–12). Mean preoperative factor VIII concentration was <1% (range, <1–3%).

Results

Mean follow-up was 8years (range, 2–16years). Mean AOFAS score at follow-up was 69 (range, 35–92) and mean Olerud score 70 (range, 30–100). Improvement mainly concerned the Pain dimension. Statistical analysis found a significant difference between pre- and post-operative clinical scores (AOFAS, P=0.004; Olerud, P=0.004). Mean factor VIII concentration at surgery was 90% (range, 24–117%), and 109% (range, 75–152%) the day following surgery. There were no cases of hematoma or surgical site infection. Radiologic fusion was systematic at a mean 3.5 months (range, 3–4months).

Conclusion

The study hypothesis was confirmed. Ankle fusion in advanced hemophilic arthropathy improved function and quality of life. Perioperative clotting factor perfusion contributed to these good results, providing supplementary prevention of hemorrhagic risk.