[Pathology of the knee in the hemophiliac patient].

Chronic haemophilic arthropathy of the knee is a debilitating condition that also carries the risk of rapid degeneration of the articular cartilage of the affected joint. The swelling is a combination of haemarthroses, irritative synovial effusions, synovial thickening and actual epiphyseal overgrowth that is the result of chronic hyperemia. In the knee joint the enlarged appearance is accentuated by quadriceps wasting. Replacement of deficient factor remains the cornerstone of management, followed by splinting in the position of function, synoviorthesis and surgical synovectomy (open or arthroscopic). End stage arthropathy of the knee is the most frequent cause of severe pain and disability in haemophiliacs. Our surgical experience may be divided into five categories: synovectomy, ostectomy, hamstring tenotomy, debridement and prosthetic arthroplasty. Over the last 20 years advanced arthropathy of the knee has been approached with a broad spectrum of procedures with varying success and durability. Early treatment and prevention of chronic synovitis and progressive arthropathy is the key. Where end stage arthropathy does occur and is severely disabling, durable, functional reconstruction with minimal risk must be our goal.