Joint distraction results in clinical and structural improvement of haemophilic ankle arthropathy: a series of three cases

Summary.  The incidence of haemophilic arthropathy in multiple joints decreased due to treatment with clotting factor. Nowadays patients are enabled to live a rather normal life, resulting in more (sports) trauma‐induced arthropathy in isolated joints like the ankle. As surgical treatment options, fusion of the tibiotalar joint and total ankle replacement are available. Both standard treatments have complications and therefore an alternative treatment is desired. In this study, treatment of haemophilic ankle arthropathy with joint distraction was explored. Three patients with haemophilic ankle arthropathy were treated with joint distraction using an Ilizarov external fixator. Clinical outcomes like function, participation and pain were evaluated in retrospect with three different questionnaires: haemophilia activities list, impact on participation and autonomy and the Van Valburg questionnaire. Structural changes were assessed blinded on X‐ray by the Pettersson score and ankle images digital analysis (AIDA) and by an MRI score. All three patients were very satisfied with the clinical outcome of the procedure. They reported a clear improvement for self‐perceived functional health, participation in society and autonomy and pain. Partial ankle joint mobility was preserved in the three patients. The Pettersson score remained the same in one patient and slightly improved in the two other patients, while joint space width measured by AIDA and the MRI score demonstrated improvement for all three patients after ankle distraction. This study suggests that joint distraction is a promising treatment for individual cases of haemophilic ankle arthropathy, without additional risk of bleedings during treatment.

[1]  Andrew H Hansen,et al.  Biomechanics of the ankle-foot system during stair ambulation: implications for design of advanced ankle-foot prostheses. , 2012, Journal of biomechanics.

[2]  C. Saltzman,et al.  Subchondral bone remodeling is related to clinical improvement after joint distraction in the treatment of ankle osteoarthritis. , 2011, Osteoarthritis and cartilage.

[3]  J. Soucie,et al.  Range of motion measurements: reference values and a database for comparison studies , 2011, Haemophilia : the official journal of the World Federation of Hemophilia.

[4]  J. Wiedel,et al.  Arthrodesis of the ankle and subtalar joints in patients with haemophilic arthropathy , 2010, Haemophilia : the official journal of the World Federation of Hemophilia.

[5]  B. Hintermann,et al.  Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series , 2010, Haemophilia : the official journal of the World Federation of Hemophilia.

[6]  Y. Takakura,et al.  Arthroscopic synovectomies combined with reduced weight‐bearing using patella tendon‐bearing braces were very effective for progressed haemophilic ankle arthropathy in three paediatric patients , 2009, Haemophilia : the official journal of the World Federation of Hemophilia.

[7]  Z. Dvir,et al.  Physical activity participation and bleeding characteristics in young patients with severe haemophilia , 2009, Haemophilia : the official journal of the World Federation of Hemophilia.

[8]  K. Mulder,et al.  Orthopaedic management of haemophilia arthropathy of the ankle , 2008, Haemophilia : the official journal of the World Federation of Hemophilia.

[9]  G. Tagariello,et al.  Total ankle replacement for end‐stage arthropathy in patients with haemophilia , 2008, Haemophilia.

[10]  C. Ko,et al.  Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty. , 2007, The Journal of bone and joint surgery. American volume.

[11]  J. Finkelstein,et al.  Response shift in outcome assessment in patients undergoing total knee arthroplasty. , 2006, The Journal of bone and joint surgery. American volume.

[12]  M. C. de Waal Malefijt,et al.  The feasibility of total ankle prosthesis for severe arthropathy in haemophilia and prothrombin deficiency , 2006, Haemophilia : the official journal of the World Federation of Hemophilia.

[13]  F. Lafeber,et al.  Unloading joints to treat osteoarthritis, including joint distraction , 2006, Current opinion in rheumatology.

[14]  P. Kersten,et al.  Measuring autonomy in disabled people: validation of a new scale in a UK population , 2006, Clinical rehabilitation.

[15]  P. Helders,et al.  Measuring patients’ perceptions on their functional abilities: validation of the Haemophilia Activities List , 2006, Haemophilia : the official journal of the World Federation of Hemophilia.

[16]  J. Bijlsma,et al.  Prolonged clinical benefit from joint distraction in the treatment of ankle osteoarthritis. , 2005, Osteoarthritis and cartilage.

[17]  P. Babyn,et al.  Compatible scales for progressive and additive MRI assessments of haemophilic arthropathy , 2005, Haemophilia : the official journal of the World Federation of Hemophilia.

[18]  J. Bijlsma,et al.  Clinical benefit of joint distraction in the treatment of severe osteoarthritis of the ankle: proof of concept in an open prospective study and in a randomized controlled study. , 2002, Arthritis and rheumatism.

[19]  K. Fischer,et al.  Changes in treatment strategies for severe haemophilia over the last 3 decades: effects on clotting factor consumption and arthropathy , 2001, Haemophilia : the official journal of the World Federation of Hemophilia.

[20]  M A Viergever,et al.  Ankle images digital analysis (AIDA): digital measurement of joint space width and subchondral sclerosis on standard radiographs. , 2001, Osteoarthritis and cartilage.

[21]  C L Saltzman,et al.  Long-Term Results Following Ankle Arthrodesis for Post-Traumatic Arthritis , 2001, The Journal of bone and joint surgery. American volume.

[22]  R. D. de Haan,et al.  Psychometric properties of the Impact on Participation and Autonomy Questionnaire. , 2001, Archives of physical medicine and rehabilitation.

[23]  J. Bijlsma,et al.  Joint distraction in treatment of osteoarthritis (II): effects on cartilage in a canine model. , 2000, Osteoarthritis and cartilage.

[24]  J. Bijlsma,et al.  Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle. , 1999, Osteoarthritis and cartilage.

[25]  J. Bijlsma,et al.  Haemophilic arthropathy resembles degenerative rather than inflammatory joint disease , 1999, Histopathology.

[26]  Phillips Am,et al.  Hemophilic ankle arthropathy. , 1996 .

[27]  B. M. Buzzard,et al.  Sports and hemophilia: antagonist or protagonist. , 1996, Clinical orthopaedics and related research.

[28]  A. M. Phillips,et al.  Hemophilic Ankle Arthropathy , 1996, Clinical orthopaedics and related research.

[29]  J. Bijlsma,et al.  Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report. , 1995, The Journal of bone and joint surgery. British volume.

[30]  H. Pettersson,et al.  A radiologic classification of hemophilic arthropathy. , 1980, Clinical orthopaedics and related research.