Multidisciplinary management of fractures in patients with hemophilia: Advances in perioperative hemostasis and functional restoration in the era of novel therapies.

Abstract

Hemophilic arthropathy remains a major cause of disability in patients with hemophilia (PwH) and often progresses to a stage requiring surgical intervention. The perioperative management of these patients is inherently complex, as it requires not only effective control of bleeding but also careful coordination across multiple clinical disciplines. In recent years, advances in coagulation factor replacement therapy and adjunctive hemostatic strategies have substantially improved surgical safety; However, perioperative decision-making continues to be challenged by variability in disease severity, joint pathology, and individual bleeding risk. This review provides a comprehensive overview of current perioperative management strategies for patients with hemophilic arthropathy undergoing orthopedic surgery. Key aspects discussed include preoperative assessment and planning, individualized coagulation factor replacement protocols, adjunctive hemostatic measures, anesthetic considerations, and postoperative rehabilitation. Particular attention is given to the role of multidisciplinary collaboration in optimizing surgical outcomes and minimizing perioperative complications. By integrating available evidence with practical clinical considerations, this review aims to highlight critical elements of perioperative care that contribute to safer surgical management and improved functional outcomes in patients with hemophilic arthropathy.