Arthroscopic debridement for ankle haemophilic arthropathy

The purpose of this study is to describe the results of arthroscopic ankle debridement (AAD) with the aim of determining whether it is possible to avoid or delay ankle fusion or total ankle replacement for advanced haemophilic arthropathy of the ankle in young patients. In a 12-year period (2000-2011), 24 AADs (one bilateral in two stages) were performed for advanced haemophilic arthropathy of the ankle in 23 patients (22 had haemophilia A, 1 haemophilia B, 0 with inhibitors against the deficient factor). Their average age at operation was 25.3 years (range 21-36). Inclusion criteria were: more than 50% of ankle motion, good axial alignment of the ankle (increased varus or valgus angulation was a contraindication for AAD) and pain greater than 6 points on a visual analogue scale (0-no pain to 10 points). Follow-up was for an average of 5.4 years (range 2-14 years). The results were evaluated retrospectively by the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. The clinical results were excellent in 13 (54.2%), good in nine (37.5%) and fair in two (8.3%). There were two (8.3%) postoperative complications (haemarthroses resolved by join aspiration). Three patients (12.5%) required an ankle fusion. AAD should be considered in the young haemophiliac to delay ankle fusion or total ankle replacement. The operation may give the patient years of life without intense pain.