The knee in severe haemophilia with special emphasis on surgical/invasive procedures.

Close collaboration between haematologists, orthopaedic surgeons, rehabilitation physicians, pediatricians, pharmacist, radiologist, pain specialist, psychologists, physiotherapists and nurses is essential for the proper handling of knee problems in haemophiliac patients. The ideal scenario would be for the primary prophylaxis (prevention of the disease) to prevent major degenerative changes that we still see so frequently in this type of patients. Until we achieve this we will continue having to perform multiple invasive orthopaedic procedures, such as articular punctures (joint aspiration) to drain haemarthrosis, radiosynovectomies, arthroscopic synovectomies, tendon lenghtenings, realignment osteotomies and total knee replacements (primary and revision) on the knees of people with haemophilia. As a result of this, we will improve the quality of life of haemophiliac patients with orthopaedic knee problems. The rate of potential complications following knee orthopaedic procedures, especially in patients with inhibitors, must not be underestimated.