Arthroscopic ankle fusion in haemophilic ankle arthropathy: A report of four cases and narrative literature review

The first aim of this study was to report the authors’ experience in the last 10 years, for ankle fusion in haemophilic ankle arthropathy. The outcome measures were the fusion rates, time to fusion, postoperative complications and revision rates. The second aim of this study was to perform a narrative literature review for the outcomes of ankle fusion in haemophilic ankle arthropathy. This was a single-centre, consecutive, 10-year retrospective case series for patients who had arthroscopic ankle fusion for haemophilic ankle arthropathy. All patients had perioperative clotting factor optimization. Out of the six identified patients, four ankle fusions in three patients met the eligibility criteria. All the patients were male and had haemophilia A. The mean age of the patients at the time of surgery was 52 years. For the literature review, PubMed, Medline and Embase were searched from inception until August 5, 2024. Seven eligible studies were included. Successful bony union was achieved in all the patients at 16 weeks postoperatively. One screw-related complication (pain) was seen in one ankle requiring removal of screws, while there was no surgical revision. All the patients rated their ankle fusions as excellent-to-good at the final clinic follow up. The literature review showed that the overall union rate from the seven studies was 100% at 4 months, postoperatively. Postoperative complications were reported in four studies (three complications-two surgical site infections and one pseudoarthrosis requiring revision). Arthroscopic ankle fusion remains an effective and safe treatment option for end-stage haemophilic ankle arthritis, with good to excellent functional outcomes.