Joint contractures in the hemophilias.

Hemophilic contracture is seen most commonly as an equinus deformity of the ankle, or at the knee or elbow in the form of a flexion deformity. The cause is either fibrosis following intramuscular hematoma, which may be complicated by a peripheral nerve palsy causing muscle imbalance, or is associated with chronic hemophilic arthropathy following recurrent hemarthroses. The introduction of home therapy is an important preventive measure, and treatment is primarily by physiotherapy, splintage, and corrective devices. The late or severe case may require surgical correction in the form of soft tissue procedures. Arthrodesis or total arthroplasty must be carried out with meticulous hemostasis and with replacement of the appropriate blood clotting factors.