Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series

Summary. The standard treatment for end‐stage osteoarthritis of the ankle joint in haemophilic patients has been fusion of the ankle joint. Total ankle replacement is still controversial as a treatment option. The objective of this prospective study was to evaluate the mid‐term outcome in patients treated with total ankle replacement using an unconstrained three‐component ankle implant. Ten haemophilic ankles in eight patients (mean age: 43.2 years, range 26.7–57.5) treated with total ankle replacement were followed up for a minimum of 2.7 years (mean: 5.6, range 2.7–7.6). The outcome was measured with clinical and radiological evaluations. There were no intra‐ or peri‐operative complications. The AOFAS‐hindfoot‐score increased from 38 (range 8–57) preoperatively to 81 (range 69–95) postoperatively. All patients were satisfied with the results. Four patients became pain free; in the whole patient cohort pain level decreased from 7.1 (range 4–9) preoperatively to 0.8 (range 0–3) postoperatively. All categories of SF‐36 score showed significant improvements in quality of life. In one patient, open ankle arthrolysis was performed because of painful arthrofibrosis. For patients with haemophilic osteoarthritis of the ankle joint, total ankle replacement is a valuable alternative treatment to ankle fusion.     

Cementless total ankle arthroplasty in diabetic neuropathic arthropathy

Background Neuropathic arthropathy (Charcot joint) is a progressive degenerative disease of a joint that may lead to severe deformity and dysfunction and it is now recognized that diabetes is the leading cause of Charcot joint. When the ankle is involved and conservative treatment fails arthrodesis has commonly been performed, whereas arthroplasty has previously been considered to be contraindicated. A total ankle arthroplasty in Charcot ankle has not been previously reported. Case report We report the case of a 45‐year old, diabetic woman with unilateral Charcot ankle. Conclusions The woman successfully completed a rehabilitation programme and, 2 years after total ankle arthroplasty, achieved independence.     

Clinical effectiveness of arthroscopic vs open ankle arthrodesis for advanced ankle arthritis: A systematic review and meta-analysis

Background:Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion.Objective:To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis.Methods:We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software.Results:A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = −2.31, 95% CI:−4.63, −2.21), intraoperative blood loss (MD = −43.37, 95%CI: −48.49, −38.25), hospital stay (MD = −1.80, 95%CI: −2.28, −1.33), and visual analog scale score (MD = −1.75, 95%CI: −2.04, −1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001).Conclusion:Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application.PROSPERO registration number:CRD42020195727.     

The haemophilic ankle

Radiation synoviorthesis is a very effective procedure that decreases both the frequency and the intensity of recurrent ankle bleeds related to ankle synovitis. The procedure should be performed as soon as possible to minimize the degree of articular cartilage damage. It can also be used in patients with inhibitors with minimal risk of complications. On average, the efficacy of the procedure ranges from 76% to 80%, and can be performed at any age. The procedure slows the cartilaginous damage which intra-articular blood tends to produce in the long term. After 30 years of using radiation synovectomy worldwide, no damage has been reported in relation to the radioactive materials. Radiation synovectomy is currently the preferred procedure when radioactive materials are available; however, chemical synoviorthesis is an effective alternative method if radioactive materials are not available. Personal experience and the general recommendation among orthopaedic surgeons and haematologists is that when three early consecutive synoviorthesis (repeated every 3 months) fail to halt synovitis, a surgical synovectomy (open or by arthroscopy) should be immediately considered. For advanced haemophilic arthropathy of the ankle, the best solution is an ankle arthrodesis. Primary prophylaxis and radioactive synoviorthesis are the best ways that we have today of protecting against haemophilic synovitis and arthropathy of the ankle joint.     

Management of equinus contractures of the ankle in haemophilia

Equinus deformity has been a significant problem in haemophilia. It causes difficulties in walking and secondary problems in adjacent joints. There are a number of potential causes in haemophilia. A careful history, examination, and plain radiographs will determine the aetiology, which frequently is multifactorial. Hopefully, prophylactic factor replacement will reduce the incidence of such problems in the future. Prompt ‘on demand’ therapy will reduce the complications of articular and soft-tissue bleeds. Physiotherapy, splints, and orthotics will usually allow a full recovery of function and comfort. Rarely, surgical intervention is required to correct articular and/or musculo-tendinous problems. The choice of surgery depends upon the cause(s) of the deformity and should only be undertaken in experienced haemophilia units following careful counselling of the patient regarding the aims and nature of the operation and the patient’s involvement in an effective rehab- ilitation programme.     

踝关节骨折畸形愈合的临床治疗

目的 探讨踝关节骨折畸形愈合的术前评估、手术方法及其临床疗效.方法 2004年6月～2011年3月,共收治踝关节骨折畸形愈合患者16例.15例患者MRI检查关节软骨损伤小于Ⅳ级,行切开截骨矫形,应用内固定加外固定支架联合固定;1例患者关节软骨损伤为Ⅳ级,行踝关节融合术.结果 16例患者均获随访,随访时间6～87个月、平均30.8个月.骨折愈合时间12 ～17周、平均13.2周.术后踝关节AOFAS评分为58～92分、平均82分,优良率为81.3％.术后无深部感染、内固定失效、骨不连、畸形复发等并发症发生.其中2例患者发生皮缘坏死,1例钉道表浅感染,且经对症处理后获痊愈.结论 MRI检查有助于评估关节软骨的损伤程度,确定手术方案,对关节软骨损伤小于Ⅳ级的患者,经截骨矫形后,应用内固定加外固定支架联合固定为一种有效的治疗方式.     

臂踝脉搏波速度测量的重复性研究

目的评价臂踝脉搏波速度测量的可靠性。方法由两名测量者对23名心血管疾病高危患者和7名健康受试者进行臂踝脉搏波速度的测量。测量分为两阶段，中间间隔2周，每一阶段在同一天上午（8：30～11：00）和下午（13：30～16：00）分别进行测量。结果重复测量方差分析显示，测量者间和测量者内（不同时间）臂踝脉搏波速度无显著性差异。心血管疾病高危患者测量者间和测量者内臂踝脉搏波速度的Pearson相关系数为0．925～0．992（P〈0.01），组内相关系数为0．924-0．992（P〈0．01）；健康受试者测量者间和测量者内臂踝脉搏波速度的Pearson相关系数为0．674-0．974（P〈0．05），组内相关系数为0．672-0．973（P〈0．05）。Bland-Altman图显示，测量者间和测量者内臂踝脉搏波速度有较好的一致性。结论在规范的测量条件下，测量者间和测量者内的臂踝脉搏波速度的重复性好。     

Arthrodesis of the ankle and subtalar joints in patients with haemophilic arthropathy

Summary. There have been only a few studies in the literature that reported on the outcome of ankle arthrodesis in patients with haemophilia; furthermore, the number of patients was usually low and the operative technique has not been uniform. The aim of this study was to evaluate the outcome of surgery in haemophilic arthropathy of the ankle and subtalar joints, using internal fixation. From 1983 to 2006, 20 fusions were performed in 13 patients with advanced haemophilic arthropathy of the ankle and subtalar joints. There were 11 ankle fusions, one isolated subtalar fusion and eight combined ankle and subtalar fusions. Three of the latter had a subtalar fusion at a second operation. The mean age at operation was 38.7 years and the mean followup was 9.4 years. In the majority of the cases, the ankle fusion was achieved by two crossing screws. For the subtalar fusion, either staples were used or the tibiotalar screws were extended to the calcaneus. Arthrodesis of the ankle was successful in all but one patient, in whose case the procedure was revised and eventually his condition was progressed to fusion. There was also one case of painless non‐union of the subtalar joint which was not revised. There was no recurrent bleeding, and no deep infection. Arthrodesis with cross screw fixation is an effective method for fusion of the ankle and subtalar joints in patients with haemophilia.     

Indications of total ankle arthroplasty for rheumatoid arthritis: evaluation at 5 years or more after the operation

Abstract

The postoperative results of total ankle arthroplasty (TAA) were surveyed, and the indications of TAA for rheumatoid arthritis (RA) were examined. We have performed TAA in properly selected patients with indication of ankle joint destruction due to RA. The subjects were 18 RA patients (20 joints) who underwent TAA between April 1988 and April 1996. Type-ND or type-TNK Bioceram was used without cement for possible revision of TAA. No destruction of large joints was found in 8 patients, and TAA was used as part of multiple arthroplasty in 10 patients. After the operation, decrease in or disappearance of joint pain was obtained, and range of motion and improved ability to walk were secured. The clinical results were superior to those obtained for 17 joints of 17 patients who underwent ankle arthrodesis during the same period. However, a radiolucent zone was observed an X-ray examination in every case, after 8 years on average (range 5–12 years) after operation. Under present conditions, ankle arthrodesis should be used for younger patients. When no destruction of the hip or knee joint is found and the patient is 65 years of age or older, we believe TAA is indicated. In cases of multiple arthroplasty or with bilateral ankle joint destruction, TAA appears to be useful if patients are young, considering their better life expectancy and quality of life.     

测量踝部动脉血压与肱动脉血压、主动脉内血压的对比研究

目的　探讨下肢血压测量方法。方法　对高血压病组及非高血压病组共 10 7例病人采取将袖带缠于小腿下端监听足背动脉血压 ,并与肱动脉血压、主动脉内血压进行对比研究。结果　两组踝部动脉血压与肱动脉血压呈显著正相关 (P <0 0 0 1) ,两组四肢血压与主动脉内血压相关性检验 ,除高血压组踝部动脉舒张压外均有显著相关性 (P <0 0 5 )。踝部动脉收缩压和舒张压平均比肱动脉分别高 10和 5mmHg;肱动脉收缩压低于主动脉内收缩压 5mmHg ,舒张压约高于主动脉内舒张压 5～ 6mmHg ;踝部动脉收缩压高于主动脉内收缩压 6mmHg ,舒张压约高于主动脉内舒张压 10mmHg。结论　测量踝部动脉血压的方法是可信的 ,但高血压组的踝部动脉舒张压与主动脉内舒张压相关性较差。