Vicious Cycle of Multiple Invasive Treatments in a Hemophilic Inhibitor Positive Child with Resistant Knee Flexion Contracture, A Case Report

Document Type : CASE REPORT


1 Department of Orthopedic Surgery Massachusetts General Hospital, 55 Fruit Street Boston, MA, 02114 USA.

2 Department of Pediatric Hematology-Oncology Dr Sheikh Pediatric Hospital Mashhad University of Medical Sciences, Mashhad, Iran.


Uncontrolled recurrent hemarthrosis can end to contracture, deformity, pain, joint destruction and gait disorders which are
disabling. We are going to report a challenge, a unilateral knee flexion contracture in a child with severe hemophilia A and inhibitor who underwent different treatment options with unsatisfactory improvement of knee range of motion. Mismanaging postoperatively, patient and parents irresponsibility in managing self-care, lack of access and affordability to treatment and unavailability of proper treatment can be the reasons of recurrence in addition to the tough nature of a patient with inhibitor.


  1. Kachooei AR, Badiei Z, Zandinezhad ME, Ebrahimzadeh MH, Mazloumi SM, Omidi-Kashani F, et al. Influencing factors on the functional level of haemophilic patients assessed by FISH. Haemophilia. 2014;20(2):185-9.

  2. Atkins RM, Henderson NJ, Duthie RB. Joint contractures in the hemophilias. Clin Orthop Relat Res. 1987; 219: 97-106.

  3. Solimeno L, Goddard N, Pasta G, Mohanty S, Mortazavi S, Pacheco L, et al. Management of arthrofibrosis in haemophilic arthropathy. Haemophilia. 2010; 16(5): 115-20.

  4. Yates P, Cornwell J, Scott GL, Atkins RM. Treatment of haemophilic flexion deformities using the Flowtron intermittent compression system. Br J Haematol. 1992; 82: 384-7.

  5. Pennekamp PH, Wallny TA, Goldmann G, Kraft CN, Berdel P, Oldenburg J, et al. Flexion contracture in haemophilic knee arthropathy-10-year follow-up after hamstring release and dorsal capsulotomy. Z Orthop Unfall. 2007; 145: 317-21.

  6. Rodríguez-Merchán EC, Magallón M, Galindo E, López-Cabarcos C. Hamstring release for fixed knee flexion contracture in hemophilia. Clin Orthop Relat Res. 1997; 343: 63-7.

  7. Wallny T, Eickhoff HH, Raderschadt G, Brackmann HH. Hamstring release and posterior capsulotomy for fixed knee flexion contracture in haemophiliacs. Haemophilia. 1999; 5(1): 25-7.

  8. Mortazavi SM, Heidari P, Esfandiari H, Motamedi M. Trapezoid supracondylar femoral extension osteotomy for knee flexion contractures in patients with haemophilia. Haemophilia. 2008; 14: 85-90.

  9. de Almeida AM, de Rezende MU, Cordeiro FG, Villaça PR, D’Amico EA, Hernandez AJ, et al. Arthroscopic partial anterior synovectomy of the knee on patients with haemophilia. Knee Surg Sports Traumatol Arthrosc.  2013. In Press.

  10. Karam MD, Pugely A, Callaghan JJ, Shurr D. Hinged cast brace for persistent flexion contracture following total knee replacement. Iowa Orthop J. 2011; 31: 69-72.

  11. Rodriguez-Merchan EC, Valentino L, Quintana M. Prophylaxis and treatment of chronic synovitis in haemophilia patients with inhibitors. Haemophilia. 2007; 13(3): 45-8.