There have only been a few studies in the literature which reported on the outcome of ankle arthrodesis in patients with hemophilia, furthermore the number of patients is usually low and the operative technique is not uniform. The aim of this study is to evaluate the outcome of surgery in hemophilic arthropathy of the hindfoot, using internal fixation.

From 1983 to 2006, 20 fusions were performed in 13 consecutive patients due to advanced hemophilic arthropathy of the hindfoot. There were 11 ankle fusions, 1 isolated subtalar fusion and 8 ankle and subtalar fusions, 3 of the latter on a second operation. The mean age at operation was 38.7 years and the mean followup was 9.4 years. Preoperativelly the mean modified Mazur score was 47.7. In the majority of cases the ankle fusion was achieved by two crossing screws, while, for the subtalar fusion either staples were used, or the tibiotalar screws were extended to the os calsis.

Arthrodesis of the ankle was successful in all but one patient, who was revised and progressed to fusion. The mean postoperative modified Mazur score was 94.9. There was also one painless incomplete union of the subtalar joint which did not need revision. There was no recurrent bleeding, and no deep infection.

Arthrodesis with cross screw fixation and staples is a quick, simple and effective method for fusion of the hindfoot in patients with hemophilia.

Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment.

The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.