Pathology of the Elbow in Haemophilia

In this article, we have reviewed the most important modern conceptual developments for the treatment of the elbow in persons with haemophilia. Despite modern preventive strategies, subclinical bleeding can still occur, underscoring the need for constant vigilance. The elbow is particularly susceptible to synovitis due to its extensive synovial tissue and multiplanar movement, which increase exposure to recurrent bleeding episodes. Iron deposition in the joint initiates a complex inflammatory and apoptotic cascade that ultimately leads to changes in the synovial membrane. Point-of-care ultrasound has become an essential tool for detecting subclinical synovitis, but ensuring diagnostic accuracy remains critical. Comprehensive treatment also requires a highly specialised musculoskeletal expert with access to the full range of therapeutic options. When conservative measures fail, rapid deactivation of the synovial tissue is imperative, and synovectomy stands out as a simple but highly effective intervention. In addition, advances in haematological care now allow the entire range of orthopaedic reconstructive procedures on the elbow to be performed safely in patients with haemophilia. In this evolving context, the role of a coordinated and specialised multidisciplinary team has become more important than ever, as it ensures the full integration of medical, rehabilitative and surgical approaches to optimise long-term joint outcomes.