Hemophilia is among the commonest bleeding disorders encountered in orthopaedic practice and results from an X-chromosome-linked failure of coagulation factors VIII (hemophilia A) or IX (hemophilia B).

Morbidity in hemophilia is a result of repeated hemarthroses, and the aim of orthopaedic management is to prevent these, to treat them promptly, and to address the joint pathology that results.

Both radiosynovectomy and arthroscopic synovectomy are effective in reducing the degree of synovitis and the number of hemarthroses, although, to our knowledge, there is little evidence that it prevents progression to end-stage arthritis. There is substantial evidence for the safety and effectiveness of radiosynovectomy, and this is the first line of treatment in our practice.

In end-stage disease, total knee arthroplasty is challenging as a result of severe contractures and is associated with a higher rate of complications such as infection (7% compared with 1% to 2% in osteoarthritis) and need for blood transfusions and a higher revision rate than that seen in total knee arthroplasty for osteoarthritis.

However, many series of total knee arthroplasty for hemophilia have now been published, and excellent results can be gained in terms of pain relief and quality of life.