Joints and Surgery

These days, there is a great deal of talk about using surgery to treat joint damage caused by hemophilia. Like inhibitors, joint damage is a major problem caused by hemophilia.16,22

When joint damage happens, there can be a good deal of pain, joint deformity, and even a decrease in joint function.4

In these cases, surgery may be an option—but the benefits of surgery need to be balanced with the risks.16,17

The Challenge of Surgery and Inhibitors

People with inhibitors face particular challenges in surgery. Bleeding occurs in any kind of surgery, but for people with inhibitors getting bleeding to stop can be more difficult.8,22

Decades ago, because of this challenge, surgical options were not available at all. Now, with the use of bypassing agents and improved surgical techniques, surgery is possible.22,23

But, if you have hemophilia with inhibitors and are thinking about surgery, there are a few things for you and your doctor to keep in mind:

  • You may need to work with a physical therapist after surgery — and possibly before.16
  • There is an increased risk of infection at the surgical site, so postoperative management should be done carefully.16,22
  • You should be alert for signs of bleeding after surgery.8,16

Also, since inhibitors often show up after surgery, your doctor will screen for changes in inhibitor levels.4

Your hematologist and orthopedic surgeon will work with you to assess the risks versus benefits in your individual situation.16,17

What Are the Surgery Options for People with Inhibitors?

Orthopedic surgery is a medical procedure to treat problems that might develop in the bones, joints, or ligaments. It is usually considered elective surgery, not required or emergency surgery.16

Below are a few types of orthopedic surgery procedures used to help treat or prevent further joint damage. They are listed in order from the least difficult to the most difficult.16


A less invasive surgical technique where a tiny camera and surgical instruments are inserted through small incisions to examine and repair damage.16


The synovium is a smooth layer of tissue that lines your joints. It produces synovial fluid that provides nourishment and helps the bones of the joint move easily.7,13

When bleeds occur, this tissue becomes thicker and swollen. Over time this swelling becomes chronic and is termed synovitis. The newly thick tissue can cause more bleeds and, over time, more pain and damage.3,16

A synovectomy removes the excess synovial tissue. The goal is to reduce the number of bleeds and prevent further joint damage.13,16

Major joint surgery

When damage to a joint is quite severe, then a synovectomy is usually no longer possible. In these cases, major joint surgery may be the best choice to provide relief and improve movement.16

Major joint surgery operations are typically performed on shoulders, elbows, hips, knees, and ankles.16

If you are considering orthopedic surgery, work with your hematologist and hemophilia treatment center to create a list of benefits and risks.

Depending on the situation, your doctor may also want to discuss fusion and joint replacement.16

Work with your hemophilia treatment center to discuss all the pros and cons of any surgery — and to create a full list of things you will need to do to be prepared.