Tibial Distal Osteotomy in Valgus Ankle in Patients with Hemophilia

Introduction: Hemophilic ankle arthropathy is the result of recurrent bleeding. Arthropathy reduces joint movement, causes chronic pain, restricts normal activity, causes depressive episodes, and diminishes quality of life. Objective: The aim the present work is to present our surgical technique for supramalleolar metaphysis osteotomy in haemophilic arthropathy with valgus deformity. Material and Method: Seven patients with Haemophilia A were treated with metaphyseal supramalleolar osteotomy. The mean age was 14 years. The mean follow up was 8 years. Osteotomies were performed in patients with joint line valgus deformity and pain. The mean angle of deformity of the joint, was 16o degrees. All patients had haemophilic arthropathy of the ankle. Preoperative planning medial wedge was calculated according to the degrees of deviation to be corrected. Results: In all patients, the joint line improved the mean was 1° and mean VAS 2.All patients showed signs of consolidation at 6 weeks. No patients had wound complications. It was not necessary to remove the osteosynthesis. Discussion: Ankle arthropathy is frequent in PWH. Synovitis must be rapidly treated, because repetitive bleeding produces cartilage damage. Joint malalignment and arthropathy are part of the same pathology, occurring after chronic synovitis. Medial supramaleolar tibial osteotomies with lateral corticotomies increase stability. The percentage of consolidation was 100%. Preoperative planning and the wedge resection were effective. Joint movement was related to the patient’s grade of arthropathy. Conclusion: Good clinical and radiologic evaluation and expertise in recognition of pain in ankle arthropathy in PWH allow surgeons to choose the treatment method.