Total Hip Arthroplasty in Patients with Hemophilia

Abstract

The most common clinical manifestation of hemophilia is arthropathy secondary to repeated intra-articular bleeding and chronic synovitis. In patients with hemophilia, 80–85% of the bleeds occur into the joints [1, 2]. The articular bleeding can cause synovial hypertrophy, and a vicious circle of chronic synovitis develops with rebleeding. The blood in the joint makes the synovial tissue become catabolically active, and inhibits synthesis of the cartilage matrix. The blood has also a direct harmful effect on cartilage irrespective of the synovial changes [3]. The articular problems in patients with hemophilia begin in the early years of life. If untreated, this condition is followed by degenerative changes, and a stiff or painful joint will result. Hemophilic arthropathy is a disabling condition that may cause chronic pain and immobilization, and impair the quality of life of the hemophiliac patient. Prophylactic therapy can slow the natural course of hemophilic arthropathy. However, due to its excessive cost, prophylaxis is only possible in a small proportion of patients with hemophilia.