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Total Ankle Arthroplasty in Patients with Hereditary Hemochromatosis

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

More than half of patients with hereditary hemochromatosis (HH) have painful arthritis, often including hindfoot osteoarthritis. Total ankle arthroplasty (TAA) is increasingly recommended for patients with painful ankle osteoarthritis. However, the pain relief and function experienced by patients continues to be debated particularly as compared with ankle fusion.

Questions/purposes

We asked whether (1) the complication rates were low; (2) the components were stable; (3) the patients achieved pain relief; and (4) the patients had satisfactory midterm function, ROM, and quality of life.

Patients and Methods

We retrospectively reviewed all 16 prospectively followed patients (21 implants) with HH who underwent ankle arthroplasty. They had an average age of 59.5 years at the time of surgery. We obtained a visual analog scale for pain, the SF-36, and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Component stability was assessed using weightbearing radiographs. The minimum followup was 3.1 years (average, 5.3 years; range, 3.1–8.6 years).

Results

Postoperatively, one patient had débridement of a painful cyst on the tibial side and one patient had a subfibular débridement with a lateral ligament reconstruction. The tibial and talar components were stable in all ankles. The average pain score decreased from 6.7 (range, 3–10) to 1.9 (range, 0–4). All eight categories of SF-36 score showed improvement. The hindfoot score increased from 46 (range, 22–67) to 84 (range, 74–94).

Conclusions

Our data suggest TAA in patients with ankle osteoarthritis secondary to HH is associated with a low risk of postoperative complications and produces pain relief and good function.

Level of Evidence

Level IV, therapeutic case series. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Richard L. Amendola for assistance in preparing the paper, Heath B. Henninger PhD for helpful discussions, and Christine L. Abraham and Michael D. Harris for correcting the manuscript. We also thank the reviewers and editors (Richard A. Brand MD and Paul A. Lotke MD) for their suggestions for strengthening the work.

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Authors and Affiliations

  1. Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, CH-4410, Liestal, Switzerland

    Alexej Barg MD, Andreas Elsner MD, Daniel Hefti MSc & Beat Hintermann MD

Authors
  1. Alexej Barg MD
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  2. Andreas Elsner MD
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  3. Daniel Hefti MSc
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  4. Beat Hintermann MD
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Corresponding author

Correspondence to Alexej Barg MD.

Additional information

One or more of the authors (BH) have received royalties from Integra Orthopedics (Plainsboro, NJ), which were given to the research fund at the clinic where the work was performed. One or more of the authors (AB) have received research funding from Swiss Society of Orthopaedics and Basel Foundation Orthopaedic Surgery and Biomechanics of Foot and Ankle.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Barg, A., Elsner, A., Hefti, D. et al. Total Ankle Arthroplasty in Patients with Hereditary Hemochromatosis. Clin Orthop Relat Res 469, 1427–1435 (2011). https://doi.org/10.1007/s11999-010-1483-5

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  • DOI: https://doi.org/10.1007/s11999-010-1483-5

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