What´s New in Orthopedic Surgery for People with Hemophilia

Modern orthopedic surgery can improve the musculoskeletal problems of people with hemophilia. The most commonly affected joints are the knees, the ankles and the elbows. The most common orthopedic procedures that PWH undergo are the following: RS, arthroscopic synovectomy, arthroscopic joint debridement, ankle arthrodesis, total joint arthroplasty and removal of pseudotumors. Every surgical procedure must be performed with adequate clotting factor coverage, following the indications of the hematologist in charge. For PWH, routine pharmacological thromboprophylaxis is not indicated. In patients with inhibitors (acquired antibodies against the deficient coagulation factor) and for the surgical removal of pseudotumors, local fibrin glue is advised. The mean infection rate with TKA in PWH is 7%. Intraarticular TXA is advised to control surgical bleeding. LIA is also recommended to control postoperative pain after TKA.