The Current Role of Ankle Arthrodesis in Hemophilic Patients



Department of Orthopaedic Surgery, La Paz University Hospital- IdiPaz, Paseo de la Castellana 261, 28046-Madrid, Spain


There are several manners to take care of the hemophilic ankle in the initial phases of degeneration of the articular
cartilage, in the event that hematologic prophylaxis is unsuccessful in accomplishing no bleeds. Some of these are
nonoperative, with which management must start. These are Physical and Rehabilitation Medicine protocols and the
utilization of orthoses (patellar tendon bearing). When these are unsuccessful, more aggressive types of treatment
can be utilized, such as radiosynovectomy and some surgical operations (open or arthroscopic removal of anterior
osteophyte of the distal part of the tibia, arthroscopic ankle debridement). Nonetheless, in the late phases of degeneration
of the articular cartilage (advanced arthropathy), the solely options are surgical: ankle fusion or total ankle arthroplasty.
The review of the literature has shown that the percentage of consolidation is between 90% and 100%, and that the
percentage of postoperative infection is between 0% and 10%%. When the Ilizarov external fixator is utilized for ankle
fusion, the percentage of pin tract infection is around 14%. Ankle fusion is a secure surgical technique that meliorates
articular pain and improves the quality of life of hemophilic patients.
Level of evidence: III


Main Subjects

  1. Rodriguez-Merchan EC. The haemophilic ankle. 
    Haemophilia. 2006; 12(4):337-44.
    2. Rodriguez-Merchan EC. Ankle surgery in haemophilia 
    with special emphasis on arthroscopic debridement. 
    Haemophilia. 2008; 14(5):913-9.
    3. Pasta G, Forsyth A, Merchan CR, Mortazavi SM, Silva 
    M, Mulder K, et al. Orthopaedic management of 
    haemophilia arthropathy of the ankle. Haemophilia. 
    2008; 14:170-6.
    4. Rodriguez-Merchan EC. Orthopaedic problems about 
    the ankle in hemophilia. J Foot Ankle Surg. 2012; 
    5. Rodriguez-Merchan EC. Management of hemophilic 
    arthropathy of the ankle. Cardiovasc Haematol 
    Disord Drug Targets 2017; 17(2):111-8.
    6. Rodriguez-Merchan EC. Risks and patient outcomes 
    of surgical intervention for hemophilic arthropathy. 
    Expert Rev Hematol. 2019; 12(5):325-33.
    7. Rodriguez-Merchan EC. Total ankle replacement 
    or ankle fusion in painful advanced hemophilic 
    arthropathy of the ankle. Expert Rev Hematol. 2015; 
    8. Mortazavi SM, Asadollahi S, Farzan M, Shahriaran 
    S, Aghili M, Izadyar S, Lak M. 32P colloid 
    radiosynovectomy in treatment of chronic 
    haemophilic synovitis: Iran experience. Haemophilia. 
    2007; 13(2):182-8.
    9. Pasta G, Mancuso ME, Perfetto OS, Solimero LP. 
    Radiosynoviorthesis in children with haemophilia. 
    Hämostaseologie. 2009; 29(Supll. 1):S62-4.
    10.Houghton GR, Dickson RA. Lower limb arthrodeses in 
    haemophilia. J Bone Joint Surg Br 1978; 60(3):387-9.
    11.Gamble JG, Bellah JA, Rinsky LA, Glader B. 
    Arthropathy of the ankle in hemophilia. J Bone Joint 
    Surg Am 1991; 73(7):1008-15. Waal Malefijt MC, Van Kampen A. Arthroscopic 
    ankle arthrodesis: a new technique. Ned Tijdschr 
    Geneeskd 1992; 136(52):2585-8.
    13.Bonnin M, Carret JP. Arthrodesis of the ankle under 
    arthroscopy. Apropos of 10 cases reviewed after a 
    year. Rev Chir Orthop Reparatrice Appar Mot 1995; 
    14.Mann HA, Biring GS, Choudhury MZ, Lee CA, Goddard NJ. Ankle arthropathy in the haemophilic patient: a 
    description of a novel ankle arthrodesis technique. 
    Haemophilia. 2009; 15(2):458-63.
    15.Tsailas PG, Wiedel JD. Arthrodesis of the ankle 
    and subtalar joints in patients with haemophilic 
    arthropathy. Haemophilia. 2010; 16(5):822-31.
    16.Tsukamoto S, Tanaka Y, Matsuda T, Shinohara Y, 
    Taniguchi A, Kumai T,et al. Arthroscopic ankle 
    arthrodesis for hemophilic arthropathy: two cases 
    report. Foot (Edinb). 2011; 21(2):103-5.
    17.Bai Z, Zhang E, He Y, Yan X, Sun H, Zhang M. 
    Arthroscopic ankle arthrodesis in hemophilic 
    arthropathy. Foot Ankle Int. 2013; 34(8):1147-51.
    18.Bluth BE, Fong YJ, Houman JJ, Silva M, Luck Jr JV. Ankle 
    fusion in patients with haemophilia. Haemophilia. 
    2013; 19(3):432-7.
    19.Baker JF, Maleki F, Broderick JM, McKenna J. 
    Arthroscopic ankle arthrodesis for end-stage 
    haemophilic arthropathy of the ankle. Haemophilia. 
    2013; 1(20):e97-9.
    20.Lane H, Siddiqi AE, Ingram-Rich R, Tobase P, 
    Scott Ward R, Universal Data Collection Joint 
    Outcome Working Group, Hemophilia Treatment 
    Center Network Study Investigators. Functional 
    outcomes following ankle arthrodesis in males with 
    haemophilia: analyses using the CDC’s Universal 
    Data Collection surveillance project. Haemophilia. 
    2014; 20(5):709-15.
    21.Brkljac M, Shah S, Hay C, Rodriguez‐Merchan EC. 
    Hindfoot fusion in haemophilic arthropathy: 6-year 
    mean follow-up of 41 procedures performed in 28 
    adult patients. Haemophilia. 2016; 22(2):e87-98. l’Escalopier N, Badina A, Padovani JP, Harroche 
    A, Frenzel L, Wicart P, et al. Long-term results of 
    ankle arthrodesis in children and adolescents with 
    haemophilia. Int Orthop. 2017; 41(8):1579-84.
    23.Eichler D, Ehlinger M, D’Ambrosio A, Desprez D, Bierry 
    G, Adam P, et al. Ankle fusion in hemophilic patients. 
    Orthop Traumatol Surg Res. 2017; 103(8):1205-9.
    24.Wang S, Li Q, Zhang Z, Wang W, Li J, Liu L. Ankle 
    arthrodesis for end-stage haemophilic ankle 
    arthropathy using a Ilizarov method. Int Orthop.