title: Total ankle replacement in patients with von Willebrand disease: mid-term results of 18 procedures.
abstract: von Willebrand disease (VWD) is a recognized cause of secondary ankle osteoarthritis (OA). Few studies have examined orthopaedic complications and outcomes in VWD patients treated for end-stage ankle OA with total ankle replacement (TAR). To determine the clinical presentation, intraoperative and postoperative complications and evaluate the mid-term outcome in VWD patients treated with TAR. Eighteen patients with VWD with mean age 47.3 years (range = 34.0-68.7) were treated for end-stage ankle OA with TAR. The mean duration of follow-up was 7.5 years (range = 2.9-13.2). Intraoperative and perioperative complications were recorded. Component stability was assessed with weight-bearing radiographs. Clinical evaluation included range of motion (ROM) tests using a goniometer and under fluoroscopy using a lateral view. Clinical outcomes were analysed by a visual analogue scale, the American Orthopaedic Foot and Ankle Society hindfoot score and Short Form (36) Health Survey (SF-36) health survey. One patient sustained an intraoperative medial malleolar fracture. In two patients delayed wound healing was observed. Two secondary major surgeries were performed. Pain level decreased from 8.2 ± 0.9 (range = 7-10) preoperatively to 1.1 ± 1.2 (range = 0-4) postoperatively. Significant functional improvement including ROM was observed. All categories of SF-36 score showed significant improvement in quality of life. Mid-term results of TAR in patients with VWD are encouraging. The total rate of intraoperative and postoperative complications was 33.3%. However, longer term outcomes are necessary to fully understand the clinical benefit of TAR in patients with VWD.
authors: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland.
authors: K
authors: K
authors: Barg
authors: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland.
authors: M
authors: M
authors: Wiewiorski
authors: Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA.
authors: A E
authors: AE
authors: Anderson
authors: Department of Dermatology Venerology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors: S W
authors: SW
authors: Schneider
authors: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors: M D
authors: MD
authors: Wimmer
authors: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors: D C
authors: DC
authors: Wirtz
authors: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland.
authors: V
authors: V
authors: Valderrabano
authors: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland.
authors: A
authors: A
authors: Barg
authors: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland.
authors: G
authors: G
authors: Pagenstert
mesh_terms: D000328:Adult; D000368:Aged; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects; D003710:Demography; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D011859:Radiography; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D005169:Factor VIII
keywords: American Orthopaedic Foot and Ankle Society hindfoot score; intraoperative complications; postoperative complications; postoperative outcome; total ankle replacement; von Willebrand disease