Hemophilic Arthropathy

The most common clinical manifestation of hemophilia is arthropathy secondary to recurrent hemarthroses and chronic synovitis. Joint-surface erosions secondary to chronic synovitis often occur in early childhood and progress to advanced arthropathy by late adolescence. The knee, elbow, ankle, hip, and shoulder are the most commonly involved joints. Management of hemophilic arthropathy has advanced with the development of purified clotting factor concentrates and procedures to prevent chronic synovitis. Radiosynovectomy using beta particle-emitting radiocolloids has been effective in dramatically reducing the frequency of hemarthroses and resolving chronic synovitis. The most common surgical procedures used to manage hemophilic arthropathy are synovectomy, joint débridement, fusion, and joint arthroplasty. Late infection and arthrofibrosis complicate joint arthroplasty more often in these patients than in patients with other forms of arthritis. The high incidence of late infection may relate to frequent intravenous self-infusion of clotting factor combined with immune suppression. Despite the medical and surgical complexities of hemophilic arthropathy, orthopaedic procedures have a high incidence of patient satisfaction.