Timothy Matthews and Andrew Carr,
Nuffield Orthopaedic Centre, Nuffield Department of Orthopaedic Surgery, Oxford OX3 7LD, UK
Disorders of haemostasis present considerable challenges to the orthopaedic surgeon. The x-linked inherited condition of haemophilia is characterised by spontaneous haemarthrosis; if left inadequately treated, recurrent bleeding will occur, leading to chronic synovitis and ultimately haemophilic arthopathy. Soft-tissue haemorrhage accounts for up to a third of all bleeding episodes and may be complicated by compartment syndrome or development of a pseudo-tumour.
Chronic synovitis unresponsive to factor replacement and physiotherapy is treated initially by chemical or radioactive synoviorthesis and failure to respond will require surgical synovectomy.
Surgical procedures are now safer and more common due to the advances in blood product technology and the multi-disciplinary approach of care from specialist haemophilia centres.
Joint debridement and replacement remain the mainstay of surgical treatment for end-stage haemophilic arthropathy.
Current Orthopaedics Volume 18, Issue 5 , October 2004, Pages 345-356.