Intraarticular bleeding and muscle bleeding occur spontaneously or as a res
ult of trauma in hemophilia A or B. The most common sites for hemarthrosis
are the knees joints, elbows and ankles joints. Resorption of intraarticula
r blood induces reactive hemophilic synovitis. Hyperplasia of the synovium
can be followed by recurrent bleedings. These early reactions can change to
a chronic synovitis and cause cartilage damage, finally resulting in a com
plete destruction of the joint. Since 1981 158 adults and 61 children with
a hemophilia A or B were treated at the Center for hemophilic disorders Fra
nkfurt in an interdisciplinary approach. Consequent prophylactic treat ment
with factor substitution can prevent the incidence of severe hemarthrosis.
Minor joint bleedings are treated by adequate factor substitution, tempora
rily non-weight bearing of the extremity, application of ice-packs and phys
ical therapy. More severe joint hemorrhages should be aspirated in order to
reduce the acute synovitis. This is followed by a consequent physical ther
apy (joint and soft tissue techniques) and anti-inflammatory drugs. The goa
l is a sufficient muscular balance of the joint, the improvement of the coo
rdination, and the proprioception. The chronic synovitis is less painful an
d poorly responses to conservative interventions. local ice application, sy
temic and local anti-inflammatory treatment support the physical therapy. S
oft heel shock absorber, elastic and semi-rigid bandages prevent recurrent
bleeding episodes by shock absorption and decrease of synovial impingement.
Synovectomy is indicated in cases of chronic persistent synovitis. Radiosy
noviorthesis (RSO), which is an alternative in certain cases, has been perf
ormed with great success in 12 cases in our hospital. In advanced arthropat
hy joint mobilization should be the emphasis of the physical therapy. Banda
ges, crutches and ortopaedic shoe devices improve the walking capacity.