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Ghasemi SA, Machi AS, Buksbaum J, Rozbruch SR, Fragomen AT. Ankle Distraction Arthroplasty: A Survivorship Review and Meta-Analysis. J Foot Ankle Surg 2023; 62:996-1004. [PMID: 37399902 DOI: 10.1053/j.jfas.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
Multiple treatments exist for ankle osteoarthritis. Ankle arthrodesis is the gold standard in late-stage osteoarthritis, but sacrifices range of motion and risks nonunion. Total ankle arthroplasty is typically reserved for low-demand patients as the long-term outcomes are poor. Ankle distraction arthroplasty is a joint sparing procedure which utilizes external fixator frame to unload the joint. This promotes chondral repair and improves function. This study aimed to organize clinical data and survivorship in published papers and direct further research efforts. Thirty-one publications were evaluated and 16 were included in the meta-analysis. The Modified Coleman Methodology Score was used to assess quality of the individual publications. Random effects models were used to estimate the failure risk after ankle distraction arthroplasty. Ankle Osteoarthritis Score (AOS), American Orthopedic Foot and Ankle Score (AOFAS), Van Valburg, and Visual Analog Scores (VAS) all improved postoperatively. Random effects model analysis revealed an overall failure ratio of 11% (95% CI: 7%-15%; p value ≤ .001; I2 = 87.01%) after 46.68 ± 7.17 months follow up, 9% (95% CI: 5%-12%; p value≤0.001 I2=81.59%) with less than 5 years follow-up and 28% (95% CI: 16%-41%; p value≤0.001 I2=69.03%) for patients with more than 5 years follow-up. Ankle Distraction Arthroplasty has promising short to intermediate term outcomes which makes this a reasonable treatment option to delay joint sacrificing surgery. The selection of the optimal candidates and consistent technique would improve research and subsequently outcomes. Based on our meta-analysis, negative prognostic factors include female sex, obesity, ROM < 20°, leg muscle weakness, high activity level, low preoperative pain levels, higher preoperative clinical scores, inflammatory arthritis, septic arthritis, and deformity.
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Affiliation(s)
- S Ali Ghasemi
- Albert Einstein Medical Center - Philadelphia, Philadelphia, PA.
| | - Anthony S Machi
- Albert Einstein Medical Center - Philadelphia, Philadelphia, PA
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2
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van Bergen EDP, Mastbergen SC, Vogely HC, Balani TN, de Kleijn P, Foppen W, van Roermund PM, Lafeber FPJG, Schutgens REG, van Vulpen LFD. Ankle joint distraction is a promising alternative treatment for patients with severe haemophilic ankle arthropathy. Haemophilia 2022; 28:1044-1053. [PMID: 35921386 PMCID: PMC9804549 DOI: 10.1111/hae.14633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Haemophilic ankle arthropathy (HAA) causes major morbidity. When conservative treatment fails, major surgical interventions are indicated. An alternative treatment to maintain joint mobility and postpone these interventions is desired. AIM To gather prospective data on clinical/structural changes after ankle joint distraction (AJD) in HAA. METHODS This study includes patients with severe HAA insufficiently responding to conservative treatment. AJD was performed during 8-10 weeks by use of an external frame. Questionnaires, physical examination and radiology were used to evaluate pain, function and structural changes before and 6, 12, 24 and 36 months after distraction. Mixed effect models were used for analysis. RESULTS This study includes eight cases (21-53 years). The fixed effects estimates of the visual analogue score (0-10) improved from 7.5 at baseline to 3.4 (p = .023) 3 years after distraction. The Haemophilia Activities List (HAL, 0-100) for basic/complex lower extremities functions improved from respectively 29.6 and 31.5 to 54.3 (p = .015) and 50.7 (p = .031). Joint mobility was maintained. Magnetic resonance imaging (MRI) showed thickened cartilage and reduced bone marrow oedema and subchondral cysts. Pin tract infections (n = 6) were effectively treated and no adverse bleeding events occurred. At 3-year follow-up, in none of the patients the originally indicated arthrodesis was performed. CONCLUSION This first prospective study showed that AJD in HAA results in decreased pain, improved function and decreased arthropathy-related MRI findings in the majority of patients for prolonged time. Although the study population is small and follow-up is relatively short, AJD may be promising to postpone invalidating interventions and might be a breakthrough treatment.
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Affiliation(s)
- Eline D. P. van Bergen
- Center for Benign HaematologyThrombosis and HaemostasisUniversityMedical Center UtrechtUniversity UtrechtVan CreveldkliniekUtrechtThe Netherlands,Departmentof Rheumatology & Clinical ImmunologyUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Simon C. Mastbergen
- Departmentof Rheumatology & Clinical ImmunologyUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - H. Charles Vogely
- Department of Orthopedic SurgeryUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Tanya N. Balani
- Departmentof Rheumatology & Clinical ImmunologyUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Piet de Kleijn
- Center for Benign HaematologyThrombosis and HaemostasisUniversityMedical Center UtrechtUniversity UtrechtVan CreveldkliniekUtrechtThe Netherlands
| | - Wouter Foppen
- Department of RadiologyUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Peter M. van Roermund
- Department of Orthopedic SurgeryUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Floris P. J. G. Lafeber
- Departmentof Rheumatology & Clinical ImmunologyUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Roger E. G. Schutgens
- Center for Benign HaematologyThrombosis and HaemostasisUniversityMedical Center UtrechtUniversity UtrechtVan CreveldkliniekUtrechtThe Netherlands
| | - Lize F. D. van Vulpen
- Center for Benign HaematologyThrombosis and HaemostasisUniversityMedical Center UtrechtUniversity UtrechtVan CreveldkliniekUtrechtThe Netherlands
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Fragomen AT. Ankle distraction arthroplasty (ADA): A brief review and technical pearls. J Clin Orthop Trauma 2021; 24:101708. [PMID: 34900579 PMCID: PMC8639464 DOI: 10.1016/j.jcot.2021.101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Ankle distraction arthroplasty (ADA) is a procedure based on the concept that mechanical unloading of an arthritic joint will initiate a healing response in the subchondral bone and articular cartilage. ADA utilizes the patient's own healing response, preserves joint motion, and is a great option for patients with osteoarthritis who are not ready for prosthetic arthroplasty or fusion. The procedure is well described and technically simple and adjunctive biologic therapies are exciting for joint regeneration. Complications are minor, and more serious adverse events are avoidable. Supramalleolar osteotomy pairs well with ankle distraction but requires some analysis and planning.
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Haelewijn N, Lobet S, Van Damme A, Docquier PL, Eerdekens M, Deschamps K. Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111405. [PMID: 34769916 PMCID: PMC8583501 DOI: 10.3390/ijerph182111405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
Ankle joint distraction (AJD) has been described to be a valuable joint-sparing alternative to arthrodesis or arthroplasty; however, clinical endpoints associated to this surgical intervention are lacking. The current case report describes clinical and biomechanical outcome measures of ankle joint distraction in a 14-year-old patient with severe haemophilia A. Because of persistent and incapacitating pain and the poor response to conservative and invasive treatment options, ankle joint distraction was performed in this 14-year-old patient using an external fixator encompassing two Ilizarov full rings in the tibia and a foot ring fixed to the foot by four K-wires. State-of-the-art medical imaging and non-invasive skin marker-based 3D multi-segment foot modelling were performed in a pre- and post-operative stage. From a structural viewpoint, this AJD was a success since it improved and stabilised the osteo-cartilaginous lesions of the ankle. Biomechanical outcome measures associated with the 18-month follow-up were found to be suboptimal, showing an early plantarflexion pattern at the ankle joint during midstance and a tendency towards increased power absorption at the midfoot with peak power absorption being almost two times higher when compared to boys of the same age. From a functional viewpoint, we observed a clear reduction in the patients’ physical activities until one year after AJD. Despite these functional and structural improvements, recurrent painful phenomena, including the development of a complex regional pain syndrome (CRPS) and a stress fracture of the third metatarsal bone, were observed which are probably related with the development of recurrent subchondral oedema.
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Affiliation(s)
- Nicolas Haelewijn
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, B-8200 Brugge, Belgium; (M.E.); (K.D.)
- Correspondence:
| | - Sebastien Lobet
- Service D’hématologie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Bruxelles, Belgium;
- Neuromusculoskeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Secteur des Sciences de la Santé, Avenue Mounier 53, B-1200 Brussels, Belgium
- Secteur de Kinésithérapie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - An Van Damme
- Service D’hématologie Pédiatrique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Bruxelles, Belgium;
| | - Pierre-Louis Docquier
- Service D’orthopédie et de Traumatologie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Bruxelles, Belgium;
| | - Maarten Eerdekens
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, B-8200 Brugge, Belgium; (M.E.); (K.D.)
| | - Kevin Deschamps
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, B-8200 Brugge, Belgium; (M.E.); (K.D.)
- Haute Ecole Leonard De Vinci, Institut D’Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Avenue E. Mounier 84, B-1200 Sint-Lambrechts-Woluwe, Belgium
- Department of Podiatry, Artevelde University of Applied Sciences, Voetweg 66, B-9000 Ghent, Belgium
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Ahn J, Yoo MC, Seo J, Park M, Jeong BO. Comparison of Total Ankle Arthroplasty and Ankle Arthrodesis in End-Stage Hemophilic Arthropathy. Foot Ankle Int 2020; 41:937-944. [PMID: 32538146 DOI: 10.1177/1071100720929002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) can result in excellent outcomes in patients with end-stage arthritis, but most patients with end-stage hemophilic ankle arthropathy (ESHAA) still undergo ankle arthrodesis (AA). The purpose of this study was to analyze clinical and radiological results of TAA and AA for ESHAA. METHODS A total of 29 cases (16 TAAs and 13 AAs) of painful ESHAA were included. For clinical outcome evaluation, visual analog scale (VAS) for pain, Foot Function Index (FFI), and range of motion (ROM) were analyzed. Postoperative clinical and radiological complications were also analyzed. The mean duration of follow-up was 6.8 ± 3.0 years. The mean age was 44.1 ± 9.9 years. RESULTS The VAS for pain was significantly improved from 5.5 ± 2.3 to 0.9 ± 1.2 (P < .001). The FFI scale was significantly improved from 61.6% ± 15.5% to 16.6% ± 15.4% (P < .001). In FFI disability and activity subscales, the TAA group exhibited meaningful outcomes relative to those of the AA group (P = .012 and .036, respectively). The total ROM in the TAA group changed from 30.8 ± 12.6 degrees to 37.3 ± 12.8 degrees at final follow-up (P = .090). Three cases of osteolysis and 1 case of heterotopic ossification were noted in the TAA group. No cases of nonunion were noted in the AA group. Progressive arthrosis of adjacent joints after AA was observed in 1 case. CONCLUSION Both TAA and AA in ESHAA exhibited significant improvement in pain based on VAS and FFI scales. Compared to AA, TAA resulted in superior outcomes in FFI disability and activity subscales, suggesting that TAA may be considered as a surgical option alongside AA for ESHAA. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jungtae Ahn
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Chul Yoo
- Department of Orthopaedic Surgery, Chung Hospital, Gyeonggi-do, Korea
| | - Jeunghwan Seo
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Moonsu Park
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Bi O Jeong
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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6
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Christensen KR, Kjelgaard-Hansen M, Nielsen LN, Wiinberg B, Alexander Althoehn F, Bloksgaard Poulsen N, Kryger Vøls K, Popp Thyme A, Maria Lövgren K, Kornerup Hansen A, Roepstorff K. Rapid inflammation and early degeneration of bone and cartilage revealed in a time-course study of induced haemarthrosis in haemophilic rats. Rheumatology (Oxford) 2020; 58:588-599. [PMID: 29982826 DOI: 10.1093/rheumatology/key186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/23/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Detailed knowledge of the sequential cell and tissue responses following haemarthrosis is important for a deep understanding of the pathological process initiated upon extensive bleeding into the joint causing haemophilic arthropathy (HA). The underlying pathobiology driving haemarthrosis towards HA has been difficult to establish in detail, although animal models have shed light on some processes. Previous studies have focused on a single or a few distant time points and often only characterizing one tissue type of the joint. The objective of this study was, therefore, to carefully map early onset of synovitis and HA following induced haemarthrosis. METHODS One hundred and thirty haemophilia A rats were subjected to induced haemarthrosis or a sham procedure in full anaesthesia and euthanized from 30 min to 7 days after the procedure. Pathological changes of the joints were visualized using micro-computed tomography, histology and immunohistochemistry. RESULTS Synovitis developed within 24 h and was dominated by myeloid cell infiltrations. Cartilage and bone pathology were evident as early as 48-96 h after haemarthrosis, and the pathology rapidly progressed with extensive periosteal bone formation and formation of subchondral cysts. CONCLUSION Fast, extensive and simultaneous cartilage and bone degeneration developed shortly after haemarthrosis, as shown by the detailed mapping of the early pathogenesis of HA. The almost immediate loss of cartilage and the pathological bone turnover suggest a direct influence of blood on these processes and are unlikely to be attributed simply to an indirect effect of inflammation.
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Affiliation(s)
- Kristine Rothaus Christensen
- Translational Haemophilia Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark
| | - Mads Kjelgaard-Hansen
- Translational Haemophilia Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Lise Nikolic Nielsen
- Veterinary Clinical and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Wiinberg
- Haemophilia Translational Biology, Global Research, Novo Nordisk A/S, Maaloev
| | | | | | - Kåre Kryger Vøls
- Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark.,Histology & Bioimaging, Global Research, Novo Nordisk A/S, Maaloev, Denmark
| | - Anders Popp Thyme
- Translational Haemophilia Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Karin Maria Lövgren
- Translational Haemophilia Pharmacology, University of Copenhagen, Copenhagen, Denmark
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7
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Haleem AM, Galal S, Nwawka OK, Balagadde A, Borst EW, Do HT, Mintz DN, Fragomen AT, Rozbruch SR. Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty. Strategies Trauma Limb Reconstr 2020; 15:157-162. [PMID: 34025796 PMCID: PMC8121115 DOI: 10.5005/jp-journals-10080-1512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Ankle distraction arthroplasty has emerged as an alternative treatment for ankle arthritis. There are few reports on the magnetic resonance imaging (MRI) findings after distraction arthroplasty. This study sought to determine whether there are positive changes on MRI after ankle distraction and improvements on X-ray. Additionally, patient-reported outcomes and joint range of motion (ROM) after ankle distraction are described. Materials and methods Thirty-two patients (mean age 49 years) who underwent ankle distraction had pre-operative and one-year postoperative MRIs, which were graded using a modified whole-organ magnetic resonance imaging score (WORMS). Ankle joint space and ROM were measured. A non-validated three-item questionnaire was administered to assess functional outcomes. Results Although the anterior quadrant of the ankle showed a trend to improvement in cartilage morphology on the postoperative MRI, the WORMS did not demonstrate a significant difference in any of its subcategories. While reduction in joint osteophytes was observed and maintained short term, this was mainly due to resection intraoperatively. X-rays revealed a significant increase in joint space, and there was a significant increase in ankle dorsiflexion. Eight-seven percent of the patients were satisfied with their functional outcome. Conclusion At short-term follow-up, MRI scores after ankle distraction arthroplasty did not demonstrate significant improvement despite positive changes on X-ray and improved clinical outcomes and ankle ROM. Further study on larger patient numbers with longer follow-up is required. Level of evidence IV, Case Series How to cite this article Haleem AM, Galal S, Nwawka OK, et al. Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty. Strategies Trauma Limb Reconstr 2020;15(3):157–162.
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Affiliation(s)
| | | | - Ogonna K Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | | | - Eugene W Borst
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - Huong T Do
- Department of Clinical Data Core, Healthcare Research Institute, Hospital for Special Surgery, New York, United States
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - Austin T Fragomen
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, United States
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8
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van Vulpen LFD, Holstein K, Martinoli C. Joint disease in haemophilia: Pathophysiology, pain and imaging. Haemophilia 2018; 24 Suppl 6:44-49. [PMID: 29878659 DOI: 10.1111/hae.13449] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2018] [Indexed: 12/25/2022]
Abstract
Haemarthroses cause major morbidity in patients with haemophilia. Blood has devastating effects on all joint components, resulting in synovitis, osteochondral degeneration and ultimately end-stage haemophilic arthropathy. Key players in this process are iron and inflammation. Preventing joint bleeds is of utmost importance to maintain joint health as targeted therapies directed against blood-induced inflammation and iron-mediated processes are lacking. Joint bleeds result in acute pain as well as chronic pain due to synovitis or arthropathy. Acute pain originates from nociceptors activated by tissue damage. In chronic inflammation, central and peripheral sensitization of nociceptors might occur resulting in chronic pain. This also triggers a series of brain disorders such as emotional fear, anxiety, mood depression and impairment of cognitive functions. Treatment of haemophilia-related pain not only consists of analgesics, but also of exercise, education and in selected cases antidepressants and anticonvulsants. For objective assessment of joint structural outcome and detecting earlier changes of haemophilic arthropathy, both ultrasound (US) and magnetic resonance (MR) imaging have shown valuable. Both can be considered equally able to reveal signs of disease activity. MR imaging is able to visualize haemosiderin deposition and is more comprehensive in depicting osteochondral changes. Disadvantages of MR imaging are the duration of the examination, evaluation of a single joint at a time, costs and may require sedation, and it may need intraarticular contrast injection to depict initial osteochondral changes with accuracy. As such, US is a more useful screening tool and can be used for repeated follow-up examinations.
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Affiliation(s)
- L F D van Vulpen
- Van Creveldkliniek University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K Holstein
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C Martinoli
- - DISSAL, Ospedale Policlinico San Martino, Università di Genova, Genova, Italy
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9
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Pathophysiology of hemophilic arthropathy and potential targets for therapy. Pharmacol Res 2017; 115:192-199. [DOI: 10.1016/j.phrs.2016.11.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 01/14/2023]
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10
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Rodriguez-Merchan EC. Joint distraction in advanced haemophilic ankle arthropathy. Haemophilia 2016; 22:e301-4. [PMID: 27227486 DOI: 10.1111/hae.12884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
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11
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Surgical Treatment of an Infected Nonunion of the Middle Third of the Femur Associated with Femoral Shortening in a Hemophilia Patient. Case Rep Orthop 2016; 2016:3045262. [PMID: 27073706 PMCID: PMC4814661 DOI: 10.1155/2016/3045262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/10/2016] [Accepted: 02/22/2016] [Indexed: 11/25/2022] Open
Abstract
The management of nonunion and limb length discrepancy has remained a constant challenge in hemophilic patients. In this study, we aimed to present the treatment of femur infected nonunion and limb length discrepancy in a twenty-seven-year-old patient with hemophilia type A. A 27-year-old male patient with hemophilia type A referred to our institution for the treatment of right femur infected nonunion and 10 cm shortness of the femur. Resection of the nonunion site and bone-to-bone fixation with autologous bone grafting were performed. Compression to the pseudoarthrosis site and distraction from new osteotomy site were applied with the unilateral external fixator. Union was achieved, and 6 cm lengthening was obtained according to the initial length. Patient was followed up for 7 years. After this treatment, the patient is able to walk with full weight bearing on the affected extremity with 4 cm shortening which is compensated by the heel lift. The results of this case indicate that limb lengthening and treatment of nonunion with the external fixation could be reliable and effective method for hemophilic patients.
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12
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Barg A, Morris SC, Schneider SW, Phisitkul P, Saltzman CL. Surgical procedures in patients with haemophilic arthropathy of the ankle. Haemophilia 2016; 22:e156-76. [DOI: 10.1111/hae.12919] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 12/14/2022]
Affiliation(s)
- A. Barg
- Department of Orthopaedics University of Utah Salt Lake City UT USA
| | - S. C. Morris
- Department of Orthopaedics University of Utah Salt Lake City UT USA
| | - S. W. Schneider
- Department of Dermatology, Venerology, and Allergology University Medical Center and Medical Faculty Mannheim University of Heidelberg Mannheim Germany
| | - P. Phisitkul
- Department of Orthopaedics and Rehabilitation University of Iowa Iowa City IA USA
| | - C. L. Saltzman
- Department of Orthopaedics University of Utah Salt Lake City UT USA
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13
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Brkljac M, Shah S, Hay C, Rodriguez-Merchan EC. Hindfoot fusion in haemophilic arthropathy: 6-year mean follow-up of 41 procedures performed in 28 adult patients. Haemophilia 2016; 22:e87-e98. [DOI: 10.1111/hae.12863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M. Brkljac
- Manchester Royal Infirmary; University of Manchester; Manchester UK
| | - S. Shah
- Department of Orthopaedic Surgery; Manchester Royal Infirmary; Manchester UK
| | - C. Hay
- Department of Haematology; Manchester Royal Infirmary; Manchester UK
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14
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Rodriguez-Merchan EC. Total ankle replacement or ankle fusion in painful advanced hemophilic arthropathy of the ankle. Expert Rev Hematol 2015; 8:727-31. [DOI: 10.1586/17474086.2015.1087846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Ravanbod R, Torkaman G, Mophid M, Mohammadali F. Experimental study on the role of intra-articular injection of MSCs on cartilage regeneration in haemophilia. Haemophilia 2015; 21:693-701. [DOI: 10.1111/hae.12659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2015] [Indexed: 12/12/2022]
Affiliation(s)
- R. Ravanbod
- Department of Physical Therapy; Biomechanical Research Laboratory; Tarbiat Modares University; Tehran Iran
| | - G. Torkaman
- Department of Physical Therapy; Biomechanical Research Laboratory; Tarbiat Modares University; Tehran Iran
| | - M. Mophid
- Department of Histology; Baquiyatallah University of Medical Sciences; Tehran Iran
| | - F. Mohammadali
- Department of Hematology; Tarbiat Modares University; Tehran Iran
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16
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Barg K, Wiewiorski M, Anderson AE, Schneider SW, Wimmer MD, Wirtz DC, Valderrabano V, Barg A, Pagenstert G. Total ankle replacement in patients with von Willebrand disease: mid-term results of 18 procedures. Haemophilia 2015; 21:e389-401. [PMID: 25688467 DOI: 10.1111/hae.12561] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 12/28/2022]
Abstract
von Willebrand disease (VWD) is a recognized cause of secondary ankle osteoarthritis (OA). Few studies have examined orthopaedic complications and outcomes in VWD patients treated for end-stage ankle OA with total ankle replacement (TAR). To determine the clinical presentation, intraoperative and postoperative complications and evaluate the mid-term outcome in VWD patients treated with TAR. Eighteen patients with VWD with mean age 47.3 years (range = 34.0-68.7) were treated for end-stage ankle OA with TAR. The mean duration of follow-up was 7.5 years (range = 2.9-13.2). Intraoperative and perioperative complications were recorded. Component stability was assessed with weight-bearing radiographs. Clinical evaluation included range of motion (ROM) tests using a goniometer and under fluoroscopy using a lateral view. Clinical outcomes were analysed by a visual analogue scale, the American Orthopaedic Foot and Ankle Society hindfoot score and Short Form (36) Health Survey (SF-36) health survey. One patient sustained an intraoperative medial malleolar fracture. In two patients delayed wound healing was observed. Two secondary major surgeries were performed. Pain level decreased from 8.2 ± 0.9 (range = 7-10) preoperatively to 1.1 ± 1.2 (range = 0-4) postoperatively. Significant functional improvement including ROM was observed. All categories of SF-36 score showed significant improvement in quality of life. Mid-term results of TAR in patients with VWD are encouraging. The total rate of intraoperative and postoperative complications was 33.3%. However, longer term outcomes are necessary to fully understand the clinical benefit of TAR in patients with VWD.
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Affiliation(s)
- K Barg
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | - M Wiewiorski
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | - A E Anderson
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - S W Schneider
- Department of Dermatology Venerology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M D Wimmer
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - D C Wirtz
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - V Valderrabano
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | - A Barg
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | - G Pagenstert
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
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17
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Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study. Haemophilia 2013; 20:e71-8. [DOI: 10.1111/hae.12320] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2013] [Indexed: 01/26/2023]
Affiliation(s)
- R. Cuesta-Barriuso
- Degree of Physiotherapy; Faculty of Health Sciences; Catholic University San Antonio; Murcia Spain
| | - A. Gómez-Conesa
- Research Group in Physiotherapy and Health Promotion; Regional Campus of International Excellence ‘Campus Mare Nostrum’; University of Murcia; Murcia Spain
| | - J.-A. López-Pina
- Department of Basic Phychology and Methodology; University of Murcia; Murcia Spain
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18
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Functional articular cartilage repair: here, near, or is the best approach not yet clear? Nat Rev Rheumatol 2013; 9:277-90. [DOI: 10.1038/nrrheum.2013.29] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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19
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van Meegeren MER, van Vulpen LFD, Roosendaal G, Lafeber FPJG, Mastbergen SC. Joint distraction: a treatment to consider for haemophilic arthropathy. Haemophilia 2012; 18:e418-20. [DOI: 10.1111/hae.12007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2012] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - G. Roosendaal
- Department of Haematology; Van Creveld Clinic; University Medical Center (UMC) Utrecht; Utrecht; The Netherlands
| | - F. P. J. G. Lafeber
- Department of Rheumatology and Clinical Immunology; University Medical Center (UMC) Utrecht; Utrecht; The Netherlands
| | - S. C. Mastbergen
- Department of Rheumatology and Clinical Immunology; University Medical Center (UMC) Utrecht; Utrecht; The Netherlands
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