A single-centre experience of 29 total ankle replacement in haemophiliac patients: Therapeutic management, factor consumption and cost

IntroductionIn patients with haemophilia, repeated bleeding in large joints leads to chronic haemophilic arthropathy, a rare disease that can be managed surgically with ankle arthrodesis or with total ankle replacement (TAR). TAR has been reported to provide good surgical results in the medium/long-term and allow preservation of joint mobility but the medical therapeutic management of the patients has not been described.AimTo describe the medical therapeutic management of TAR.MethodsAll patients with haemophilia A/B, with haemophilic ankle arthropathy, and who underwent TAR between April 2006 and October 2019 were retrospectively included. Factor consumption, perioperative and early complications, volume of blood lost, and orthopaedic data were collected.ResultsA total of 25 patients underwent 29 TAR (mean age was 44.7 years [range: 26-65]). In the 17 patients with HA without history of anti-FVIII inhibitor, the mean +/- SD consumption the day of surgery was 116 +/- 16 UI/kg when clotting factors were administered by continuous infusion, 106 +/- 13 UI/kg when SHL factors were administered by bolus infusion, and 75 +/- 22 UI/kg when EHL factors were administered by bolus infusion. During hospitalisation, the mean factor cost was euro38,073 (83.7% of the total cost of surgery). Mean blood loss was significantly lower in patients treated with tranexamic acid (164 mL, range: 40-300) than in those not (300 mL, range: 70-800; p = .01). Six patients had haematoma. The 10-year survival free of any prosthesis removal/arthrodesis was estimated to be 92.2% (95% CI [83; 100]).ConclusionThe medical therapeutic management of TAR is complex, carried out by a multidisciplinary team but effective in avoiding the occurrence of complications.