# Bilateral Total Ankle Arthroplasty in a Hemophiliac Patient: A Case Report and Literature Review

## TL;DR

This paper presents a case of a hemophiliac patient who underwent successful bilateral ankle surgery and reviews the challenges and considerations for such procedures.

## Contribution

The paper provides a detailed case report and insights on performing bilateral total ankle arthroplasty in a hemophiliac patient.

## Key findings

- Bilateral total ankle arthroplasty can be performed in a single procedure for hemophiliac patients with proper precautions.
- The case highlights the importance of meticulous preoperative, intraoperative, and postoperative care for hemophiliac patients.
- The paper compares its approach with existing literature to guide future surgical decisions.

## Abstract

Background: Ankle osteoarthritis (OA) in hemophiliac patients is an important cause of morbidity. The management of such cases presents unique challenges due to coagulopathy management and surgery technique, especially when it is bilateral. While arthrodesis has traditionally been the procedure of choice for advanced ankle OA, total ankle arthroplasty (TAA) has become an increasingly valuable option due to its potential to restore mobility and function. There is still limited information in the literature regarding the management of these cases, and many questions remain, such as whether to perform surgery in a single stage or two, whether to use anticoagulants or not, and whether to use a tourniquet or not, in addition to the extra precautions required for hemophiliac patients. Methods: This work consists of a case report and a narrative literature review. Results/Case Report: In this article, we present a surgical case involving a young hemophiliac patient with advanced bilateral ankle osteoarthritis who underwent total ankle arthroplasty in a single procedure. In addition to detailing the surgery, we provide several insights that may assist during the intraoperative and postoperative phases, and we compare our approach with the existing literature. Conclusions: With advances in materials and surgical techniques, total ankle arthroplasty has become a viable option, provided that all necessary precautions are meticulously observed. These precautions encompass not only the management of the underlying condition but also careful attention to preoperative, intraoperative, and postoperative care. Further studies with longer follow-up and the use of newer-generation prostheses are still needed.