Abstract
Between 1998 and 2007, fifteen patients with haemophilia A underwent 21 ankle arthrosco-pies+/− arthroscopic cheilectomy in order to attempt symptomatic relief of arthrosis and to increase the range of motion. All patients had severe degenerative changes radiologically.
Perioperative management was shared with our local dedicated Haemophilia service and the management algorithm will be presented.
Outcome data for pain and range of motion shows only moderate benefits.
Two patients had good relief of symptoms for 6 months. Two patients however chose to return for arthroscopies to the contralateral ankle and two had arthoscopies to the same ankle.
Follow up data is not currently available for 4 patients and the rest required fusion with a median time to fusion of 1 year.
Two patients had a documented increased range of motion, but one of these patients had an increased level of pain associated with the increased mobility.
There was 1 major complication, namely an aneurysm of the tibialis anterior artery.
Two patients had recurrent bleeds following surgery requiring ongoing and prolonged factor VIII treatment.
Average patient stay was 3.1 days, range 2 to 5 days and this stay is shorter for later years than earlier years.
The post-operative requirement for extra factor VIII ranged from 4 postoperative doses to 3 weeks ongoing treatment, median 10 doses. The average cost per dose was approximately £1128, giving a median cost of £11280 per case.
In summary, this procedure seems to be expensive in terms of QALY gains and has low rates of success in terms of function and pain relief.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
