title: [Surgical treatment for hemophilia induced lesions of foot and ankle].
abstract: OBJECTIVE
  To explore perioperative management and postoperative effectiveness of hemophilia induced lesions of the foot and ankle.
  
  
  METHODS
  Between June 1998 and February 2012, 10 cases (12 feet) of hemophilia induced lesions of the foot and ankle were treated with surgery, including 9 cases (11 feet) of hemophilia A and 1 case (1 foot) of hemophilia B. Single foot was involved in 8 cases and both feet in 2 cases, including 3 left feet and 9 right feet. All were males, aged from 13-41 years (mean, 22.6 years). Disease duration was 5-84 months (mean, 32.2 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.2 +/- 21.1. Short Form 36 Health Survey Scale (SF-36) score was 45.4 +/- 20.0. All patients were given clotting factors (2 000-3 500 U) for pre-experiment and clotting factors substitution therapy was performed perioperatively. Four cases (4 feet) underwent arthrodesis, and 7 cases (8 feet) underwent Achilles tendon lengthening/tendon transposition (1 patient underwent tendon lengthening on the left foot and arthrodesis on the right foot).
  
  
  RESULTS
  The operation time was 65-265 minutes (mean, 141.1 minutes); 1 case had 400 mL blood loss and 200 mL autogenous blood transfusion, the other cases had less than 50 mL blood loss and no blood transfusion. Wounds healed by first intention in all patients, no postoperative infection, deep vein thrombosis, or other complications occurred. All cases were followed up 6 months to 14 years and 3 months (median, 22 months). The X-ray films at last follow-up showed the patients undergoing arthrodesis obtained complete joint fusion. AOFAS scores at postoperative 6 months and last follow-up were 78.8 +/- 14.7 and 75.8 +/- 14.5, respectively; SF-36 scores were 76.6 +/- 13.1 and 75.5 +/- 13.2, respectively; and significant differences were found when compared with preoperative scores (P < 0.05), but no significant difference between postoperative 6 months and last follow-up (P > 0.05).
  
  
  CONCLUSIONS
  For patients with hemophilia induced lesions of the foot and ankle, surgical treatment could relieve foot and ankle pain and improve the function. Clotting factors pre-experiment at preoperation and substitution therapy at perioperation can reduce the risk of severe postoperative hemorrhage.
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, P.R.China.
authors.forename: Linghan
authors.initials: L
authors.lastname: Zhang
authors.forename: Xisheng
authors.initials: X
authors.lastname: Weng
authors.forename: Guixing
authors.initials: G
authors.lastname: Qiu
authors.forename: Peng
authors.initials: P
authors.lastname: Gao
authors.forename: Wenwei
authors.initials: W
authors.lastname: Qian
authors.forename: Yipeng
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000125:Achilles Tendon / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000601:surgery; D000843:Ankle Joint; D001174:Arthrodesis / Q000379:methods*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D003286:Contracture; D005500:Follow-Up Studies; D005528:Foot; D005534:Foot Diseases / Q000209:etiology / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000209:etiology / Q000601:surgery*; D059408:Pain Management; D019990:Perioperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013709:Tendon Transfer; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001779:Blood Coagulation Factors