Hemophilic arthropathy. Current concepts of pathogenesis and management

Abstract

The development of practical concentrates of Factors VIII and IX has revolutionized the management of hemophilic arthropathy, which formerly crippled hemophiliacs and condemned them to a life of pain. The orthopedic surgeon and hematologist can now achieve considerable success in reversing, controlling and correcting hemophilic arthropathy. The finding of high levels of proteolytic enzyme activity in these joints offers an explanation for the inflammatory nature of the arthropathy and a rationale for the treatment outlined. Further development of home care programs should lessen the dependency of hemophiliacs on hospitals. Standardized and reliable techniques for knee and elbow arthroplasty are needed. Further investigation into the nature of hemophilic arthropathy will clarify the role of surgical and possibly chemical synovectomy in the management of hemophiliacs. It is likely that the surgical care of these patients will become feasible in clinical centers generally, rather than just in the few hemophilic centers now active.