Orthopedic Surgery Is Possible in Hemophilic Patients With Inhibitors

Hemophilia is an inherited recessive sex-linked bleeding disorder. An insufficiency of coagulation factor VIII produces hemophilia A, and lack of factor IX causes hemophilia B. Prevention and management of the disease require intravenous infusion of the deficient factor. Worldwide, hemophilia affects approximately 600,000 people, 20% of whom develop antibodies against the deficient coagulation factor. Hemophilic patients with inhibitors present with multiarticular joint degeneration (hemophilic arthropathy) secondary to recurrent hemarthroses. The availability of activated prothrombin complex concentrates and activated recombinant factor VII allows hemophilic patients with high inhibitor titers to undergo elective orthopedic surgery with a high expectation of success, and thorough individual case analysis by a multidisciplinary team allows surgeons to obtain satisfactory results. However, the rate of potential complications must not be underestimated.