Surgical management of musculoskeletal involvement in hemophilic patients.

Since the establishment of a Hemophilic Center at the National Taiwan University Hospital in 1984, all hemophilic patients have been registered. They have received regular follow-ups by specialists in appropriate fields. Orthopedic surgeons are assigned to evaluate and handle the complications of the musculoskeletal system. From January 1984 to April 1988, 20 of these patients were referred for various reconstructive procedures. Seventeen had a moderate to severe depletion of factor VIII and 2 had a severe factor IX deficiency. The indications for surgery include pain, swelling, frequent bleeding, and flexion contracture of the involved joints. Knee joints outnumbered the others. The operative procedures included: synovectomy in 7 patients, total knee replacement in 3 patients, total hip replacement in 1 patient, tendon reconstruction and supracondylar osteotomy of the femur in 3 patients, excision of a pseudotumor or cyst in 4 patients and amputation in 2 patients. Postoperatively, joint pain was relieved greatly, recurrent bleeding became rare and walking ability was significantly improved. To prevent a decrease in the arc of motion of the operated knee joint, exercise was initiated early using a continuous passive motion machine with promising results. Postoperative complications were minimal. Indications for various surgical procedures, and the details of hematological handling are discussed.