Surgery
Many patients with haemophilia will undergo orthopaedic interventions to manage their pain and improve joint function. All invasive procedures must be performed under the protection of Clotting Factor replacement. All surgeries should be discussed with your haemophilia team prior to the procedure.
- Acute pain from recurrent bleeding into target joints (elbows, knees, ankles) can be helped by procedures such as synovectomy
- Chronic pain from an irreversibly damaged joint can be relieved by procedures such as joint replacement
Synovectomy
This is the removal of the synovium to reduce the number of bleeds within a damaged joint. After removal, the synovium grows back but is no longer thick and engorged with blood vessels as before (see Damaged joints). There are three types of synovectomy:
- Radioactive - A radioactive isotope is injected into a target joint to reduce the amount of swollen synovium
- Arthroscopic - A tiny camera is inserted into a joint, via small surgical incisions, to guide the removal of the synovium through other incisions. This procedure is usually conducted under general anesthetic and can be used for ankles, knees and elbows
- Open - Under a general anesthetic, the joint capsule is opened surgically, through an incision, and the synovium removed. This technique, however, is becoming rarer in practice
Joint replacement
When joint damage causes severe pain that interferes with day-to-day life, joint replacement is an option. Knee and hip replacements are the most common surgeries, while elbow, shoulder and ankle replacements are less frequent due to their complexity.
- Knee replacement surgery involves replacing the damaged joint and adjacent bone with plastic and metal components
- Hip replacement surgery involves swapping the damaged joint and adjacent bone with a metal ball and a plastic cup
Most people who’ve undergone hip or knee replacement surgery are walking within two days, and are discharged from hospital within two weeks. Physiotherapy may be started to aid recovery and rehabilitation, and improvement continues for up to six months. Most people are left with a pain-free joint. The new joint typically lasts around 10-15 years, though will have to be replaced sooner if it wears out or becomes loose. Talk to your haemophilia healthcare professionals if you’d like to know more.
Other surgeries
A few other surgical options are available to manage pain from damaged joints.
| Joint | Procedure | Details |
|---|---|---|
| Ankle | Cheilectomy | Removal of small bony growths around the joint margins |
| Arthrodesis | Fusion of the joint leaving it painless and immobile | |
| Elbow | Radial head excision |
Removal of the radial head to improve rotation of the forearm |
| Hip | Girdlestone | Removal of the ball part of the femur to allow a 'fibrous union' (dense scar tissue that connects the bones) to develop; this may be conducted if a hip replacement fails |
| Knee | Osteotomy | Removal of a wedge of bone from the femur or tibia to realign the leg and reduce pain |
