Orthopedic management in hemophilia: a Spanish outlook

Hematologists are of the opinion that orthopedic surgeons will eventually not be required in the clinical management of patients with hemophilia. Although such a belief is indicative of a strong desire to end the orthopedic complications associated with hemophilia, this has yet to become reality. Current knowledge and appropriate prophylactic treatment have the potential to reduce the level of orthopedic problems affecting hemophilia patients, but optimal therapy cannot be implemented globally. The Spanish Health System places no restrictions on the treatment of patients with hemophilia, and consequently children with this condition have better musculoskeletal status than their counterparts of 30 years ago. Unfortunately, older patients continue to present with severe articular deformities that require the intervention of an orthopedic surgeon. This article considers surgical techniques used to address orthopedic problems associated with hemophilia, and reviews procedures frequently performed in Spanish clinics. These include arthrocenteses, radioactive synoviortheses, arthroscopic synovectomies and articular debridements, tendon lengthening, alignment osteotomies, joint arthroplasties, opening of compartment syndromes, and removal of pseudotumors.