title: Hindfoot fusion in haemophilic arthropathy: 6-year mean follow-up of 41 procedures performed in 28 adult patients.
abstract: BACKGROUND
  Haemophilic arthropathy of the ankle is rare disorder caused by recurrent haemarthorses beginning in early adulthood.
  
  
  OBJECTIVE
  Our aim was to evaluate the fusion rate of various techniques of hindfoot fusion using internal fixation for the treatment of haemophilic arthropathy of the hindfoot.
  
  
  METHODS
  We have evaluated the fusion rate of various techniques of hindfoot (tibiotalar and subtalar joints) fusion for the treatment of haemophilic arthropathy of the hindfoot. Twenty-eight patients underwent a total of 41 procedures. Thirty-four ankle (tibiotalar) fusions were performed, seven were done arthroscopically, six using a minimal access approach and 21 with an open approach. There were two isolated subtalar fusions, three combined tibiotalar and subtalar fusions, one of which included a talonavicular fusion at the second operation. There was one peritalar ankle fusion (tibiotalar, subtalar and talonavicular). The mean age at operation was 40.3 years (SD, 12.3; range, 18.7-65.7 years). The mean time to last follow-up was 77 months (SD, 50.4; range, 7-190).
  
  
  RESULTS
  The overall non-union rate was 9.7%. All non-unions occurred in tibiotalar fusions (there were no non-unions in cases of subtalar or talonavicular fusion). A single deep infection (2.4%) occurred in an arthroscopically fused ankle. The revision rate was 4.8% (2 cases) and was carried out for non-unions. Both revisions were successful.
  
  
  CONCLUSIONS
  Hindfoot arthrodesis in patients with haemophilic ankle arthropathy provides a high fusion rate with few complications. Arthroscopic tibiotalar fusion did not result in shorter hospital stays. Revision surgery for the haemophilic hindfoot is successful, and fusion of the entire hindfoot can be achieved without complications.
authors.affiliation: Manchester Royal Infirmary, University of Manchester, Manchester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Brkljac
authors.affiliation: Department of Orthopaedic Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Haematology, Manchester Royal Infirmary, Manchester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Hay
authors.affiliation: Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain.
authors.forename: E C
authors.initials: EC
authors.lastname: Rodriguez-Merchan
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle / Q000002:abnormalities*; D005260:Female; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000601:surgery; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D013977:Tibia / Q000002:abnormalities / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ankle; arthropathy; fusion; haemophilia