In haemophilic individuals, due to repeated intraarticular bleeds, there is chronic irritation of the joint synovium leading to scarring of this synovium (fibrosis). Iron deposition in this synovium makes it thick and heavily pigmented. The iron also causes damage to the articular cartilage. Bleeding in the muscles also causes scarring in the muscles hence contractures. Sometimes nerves are compressed leading to neuropraxia and weakness with further deformity.

Clinical features – Male, when starts walking gets repeated swellings of the weight bearing joints (knee, hip, ankle). Later gets contractures and deformities of the involved joints.
The joint degeneration begins before 15 yrs and later in the disease instability begins.


Generalized - factor VIII & IX.
Locally for the involved joint -

Acute cases Splinting of joint

Once acute case subsides the aim is to prevent joint contractures, stiffness and muscle weakness – by giving physiotherapy, intermittent splintage, tractions or passive connection.

Surgical treatment – before surgical correction, correction of the clotting mechanism is a must.

Surgical procedure in the form of  
  tendon lengthening
  Arthrosclerosis of knee, ankle
  Joint replacements


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