Abstract
Hemophilia is an inherited recessive, sex-linked bleeding disorder. The lack of sufficient
coagulation factor VIII produces hemophilia A, and the lack of factor IX causes hemophilia
B. The prevention and treatment of the disease requires intravenous infusion of the
deficient factor. Hemophilic patients present with multiarticular joint degeneration
(hemophilic arthropathy), secondary to recurrent hemarthroses. With the availability
of deficient factors, hemophilic patients requiring elective ankle surgery can undergo
such surgery with a high expectation of success. A thorough analysis of each case
by a multidisciplinary team will increase the likelihood of successful surgical intervention
in the hemophilic patient. Radiosynovectomy decreases both the frequency and the intensity
of recurrent ankle bleeding episodes related to ankle synovitis. The general recommendation
is that when 3 early consecutive radiosynovectomies (repeated every 6 months) fail
to halt synovitis, arthroscopic synovectomy should be considered. For advanced hemophilic
arthropathy of the ankle, the first alternative for treatment, in our opinion, is
arthroscopic ankle debridement. In the most severe cases, we recommend either ankle
arthrodesis or total ankle replacement. In every other case, we feel that the best
therapy is prophylaxis and radiosynovectomy in order to avoid hemophilic synovitis
and ankle arthropathy.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: July 12, 2012
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
