Current treatment of hemophilic arthropathy.

Hemophilic arthropathy occurs in all patients with severe and moderate hemophilia A and B in early adolescence after repeated bleeding in a major joint unless treated with replacement of the missing factor. Regular infusions of recombinant factor or treated plasma derived factor given prophylactically to prevent spontaneous bleeding are recommended for all children to maintain a plasma factor level of >1%. Recombinant factor product or treated plasma derived product should be used. Prophylaxis should begin when bleeding occurs repeatedly and is superior to on-demand therapy. Hypertrophied synovium should be removed surgically or with a sclerosing agent, either radioactive or chemical material, to impede further cartilaginous and bony deterioration. Arthroplasty of the knee and hip have been successful in reducing pain and loss of motion when other efforts to control synovial hypertrophy fail.