S. Mastbergen (Utrecht, NL)
University Medical Center Utrecht Rheumatology & Clinical ImmunologyPresenter Of 1 Presentation
18.3.10 - The Value of Ankle Joint Distraction in Hemophilic Arthropathy: Three-year Follow-up From the First Prospective Pilot Study
Abstract
Purpose
Hemophilic ankle arthropathy (HAA) causes major morbidity in (young) patients. Often major surgical interventions like arthrodesis are indicated impacting quality of life severely. Joint distraction has been demonstrated a good joint-preserving alternative in osteoarthritis and retrospective evaluation of three patients with HAA treated with ankle joint distraction (AJD) showed evident clinical and structural improvements. This open prospective study aims to add evidence for the value of AJD in HAA.
Methods and Materials
Patients ≥18 and ≤55 years with severe complaints of HAA and eligalble for arthrodesis were included in this open prospective study. AJD was applied for 8-10 weeks by use of an external frame with 5mm distraction. Data on clinical efficacy and tissue structure changes were gathered before distraction and 6, 12, 24 and 36 months after distraction.
Results
So far eight cases (age 21-53 years) are included. The pain scores decreased significantly at on year which further decreased over time as assessed by the Visual Analogue Score and Ankle Osteoarthritis Score pain score (see figure). Similar, the median AOS function score decreased significantly over time The functional limitations as assessed by the Hemophilia Activities List for simple lower extremities functions improved significantly. The range of motion of the joint was maintained. MRI showed decreased edema and subchondral cysts and thickened cartilage indicating sustainable structural improvements. The main side effect was pin tract infection (6 patients), effectively treated with a short course of antibiotics. There were no adverse bleeding events. In none of the patients the originally indicated arthrodesis was performed.
Conclusion
This first prospective pilot study showed that AJD in HAA results in decreased pain, improved function, and tissue repair for prolonged time. Though explorative, this joint-preserving therapy may be promising to be an joint preserving surgical intervention.