[Algorithm for the treatment of the haemophilic arthropathia of the upper ankle joint]

The upper ankle joint is one of the target-joints of the haemophilic patient. Therefore, the secondary arthritis of the upper ankle joint is one of the most frequent forms of haemophilic arthropathy. It is a secondary form of arthritis not only because of chronic synovitis and cartilage injury resulting from chronic recurrent intraarticular bleeds, but also due to the misalignment of the joint and abnormal joint stress. The consequences are manifest even in young patients and finally lead to upper ankle joint arthritis. In such clinical situations, the upper ankle joint-arthroplasty is a viable alternative to arthrodesis. After several years of bleeding of the upper ankle joint many patients with haemophilia suffer from symptomatic arthritis. Open joint cleansing considerably improves mobility in the upper ankle joint and alleviates the pain in the talonavicular joint. However, the recovered mobility of the arthritic upper ankle joint also activates arthritis, associated with severe pain. With no contraindication to upper ankle joint replacement, a cement-free prosthesis can be implanted. Three months after surgery, the patients are mobile, with good foot rolling properties without orthopaedic aids and without pain in the upper joint ankle. Concludion: In terms of biomechanics the upper ankle joint-arthroplasty is a superior alternative to arthrodesis in haemophilia patients. In order to minimize the complication rate, their treatment should be restricted to specially equipped interdisciplinary centers with adequately trained and experienced surgeons as well as haemostaseologists.