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.