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J Am Acad Orthop Surg, Vol 12, No 4, July/August 2004, 234-245.
© 2004 the American Academy of Orthopaedic Surgeons
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Hemophilic Arthropathy

James V. Luck, Jr, MD, Mauricio Silva, MD, E. Carlos Rodriguez-Merchan, MD, Navid Ghalambor, MD, Christopher A. Zahiri, MD and Richard S. Finn, MD

Dr. Luck is Chief, Orthopaedics–Hemophilia Treatment Center, Orthopaedic Hospital, Los Angeles, CA, and Professor and Executive Vice Chairman, Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles. Dr. Silva is Visiting Assistant Professor, Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles. Dr. Rodriguez-Merchan is Consultant Orthopaedic Surgeon, Service of Traumatology and Orthopaedic Surgery, and Hemophilia Center, La Paz University Hospital, Madrid, Spain. Dr. Ghalambor is Assistant Clinical Professor of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA. Dr. Zahiri is Hand Fellow, Department of Orthopaedic Surgery, Loma Linda University, Loma Linda. Dr. Finn is Clinical Instructor, Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles.

Reprint requests: Dr. Luck, Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007.

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.




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C. Tsoukas, M. E. Eyster, S. Shingo, S. Mukhopadhyay, K. M. Giallella, S. P. Curtis, A. S. Reicin, and A. Melian
Evaluation of the efficacy and safety of etoricoxib in the treatment of hemophilic arthropathy
Blood, March 1, 2006; 107(5): 1785 - 1790.
[Abstract] [Full Text] [PDF]


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