For people living with hemophilia, bleeds can sometimes occur into the joints, especially hinged joints, such as, knees, elbows and ankles. If these bleeds happen multiple times into a joint then the joint could become damaged and degraded, potentially leading to arthropathy or 'arthritic damage' which may benefit from surgery. The following video will provide more information about arthropathy.

Elective Orthopedic Surgery or 'EOS' can refer to a wide range of surgical procedures, from less invasive minor surgery, such as the removal of fluid from a joint, through to a potential joint replacement. EOS can have a number of benefits, such as, helping to mobilise the joints and reduce any pain associated with the joint, ultimately improving quality of life.

It is important to remember that EOS is a decision made between the person living with hemophilia and the healthcare team. With new treatment options, it is hopeful that EOS will not be needed; however, if it is, we hope these pages can provide you with enough information and support that you feel able to have an open discussion with your healthcare team about EOS.

There are several different types of EOS ranging from removing excess fluid from a joint, to joint replacement surgery. The following information is for information purposes only and the type of EOS procedure will be decided by the MDT based on the individual person's needs.

Joint 'aspiration', or 'fluid removal' can sometimes be performed to alleviate associated pain and to debulk the joint blood in the elbows, knees or ankles as the result of recurrent bleeds. It involves removing fluid directly from the joints with a needle and fluid is drawn out into a syringe (aspirated). This procedure can usually performed as an outpatient, using a local anaesthetic. The procedure should only take about 5–10 minutes. Hip or shoulder aspiration, however, are considered to be orthopedic procedures and will need to be carried out under anaesthesia in an operating theatre.

The space inside a joint is surrounded by a membrane called the synovium and is filled with a lubricant called synovial fluid. Recurrent bleeding into a joint means that the joint can reach a state of chronic inflammation (synovitis) that increases the risk of bleeding. The swollen membrane (synovium) tissue lining can be removed to decrease the frequency and intensity of bleeding into the joint. This can be done either by synoviorthesis or synovectomy. Synoviorthesis is non-surgical removal of the swollen membrane (synovium) using chemical or radiological infusions. The chemical or radioactive compound will be injected into the joint. Synovectomy is a surgical removal of the swollen membrane (synovium).

Total joint replacement or 'arthroplasty' involves removal of the damaged bone and joint tissue and replacement with metal, ceramic or plastic prostheses; however are generally only needed for severe pain or disability. Total joint replacement is a surgical procedure that requires a rehabilitation programme and preventative measures to avoid infection. The procedure requires around a 2 weeks stay in hospital and is performed under a general anaesthetic. During the hospital stay, factor levels are monitored to control any bleeding episodes, and a physical therapy programme is provided. 

The following video will provide more information about different surgical procedures. Also, if you wish to read about any procedures in more detail, download the EOS booklet.

This material is for educational and informative purposes only. It should not replace any advice or information provided by your hemophilia specialist and/or other healthcare professionals. Surgery in patients with hemophilia (with or without inhibitors) can carry specific risks that should be carefully assessed and discussed with your hemophilia specialist and multidisciplinary care team. Surgery in patients with hemophilia (with or without inhibitors) should always be done in consultation with a specialised hemophilia treatment centre.