Surgical management of advanced hemophilic arthropathy. An overview of 20 years' experience.

Advanced hemophilic arthropathy often causes moderate to severe pain and significant incapacity by the third or fourth decade of life. Most of these patients can be managed conservatively with clotting factor replacement on demand, therapeutic exercises, antiinflammatory drugs, orthoses, and activity restriction. Some patients, however, have such severe pain and disability and frequent need for clotting factor replacement that reconstructive surgery is required. Over the last 20 years at the present authors' institution, 168 such procedures have been performed. Of these, 141 were primary procedures and 27 were reoperations for persisting or recurring symptoms, failed prostheses, and infection. End-result analysis at the latest follow-up examination indicates that all patients are improved in terms of recurrent hemarthroses and pain, and all but two are improved in terms of function. Results are analyzed and compared with existing reports in the world literature in order to determine appropriate indications for surgery and which procedures are most successful.