The place where two bones meet is called a joint. A healthy joint is able to move freely because your bones can glide past each other.
The joint is surrounded by a joint capsule, which is lined by a thin membrane called the synovium. Damage to the synovium can be fixed using a surgical procedure called a synovectomy, which removes the damaged synovium. Your doctor will only recommend this if the damage is severe and pain is chronic.
When you have a bleed, it can damage the surrounding tissues. If you severely damage a joint, you may need to see an orthopaedic surgeon, a surgeon who specializes in fixing bones and joints. The orthopaedic surgeon will review your X-ray and MRI images to assess exactly what is going on within your joint. They may recommend surgery, but this depends on a variety of factors such as:
- your age
- the severity of your hemophilia
- inhibitor status (you will learn more about inhibitors in the next section).
Surgery might help to restore some of the function you have lost. It will also hopefully reduce pain in that joint.
How orthopaedic surgery works
Damaged bones become rough or irregularly shaped, preventing them from moving freely. It also makes the joint very painful when you try to move it. The surgeon will first try to smooth out any rough or irregular edges on your bone. This can help your bones glide smoothly over each other.
Fusing the joint
Smoothing your bones may not be enough if your joint is in a more serious condition. In this case, the surgeon will try to fuse the bones together – effectively ‘removing’ the joint itself. By fusing a joint, there is no space for the blood to spread into and cause damage – preventing a bleed from ever occurring again. However, this procedure keeps your joint in a permanent, fixed position. If you get this surgery on an ankle or knee, you may need assistive devices to help you walk.
Joint replacement
The final option for a severely damaged joint is a joint replacement. During this procedure, the surgeon removes the damaged areas of your joint and replaces it with an artificial one made of strong, biologically appropriate materials. The recovery period from this procedure is long. You can reduce the recovery time by following exercise routines from your physiotherapist prior to surgery. Your physiotherapist can help you prepare for a joint replacement surgery by strengthening your muscles. This can help reduce the recovery time after the surgery.
Remember, doctors will only recommend surgery when joint damage is severe.
While surgery will improve a severely damaged joint, it will also have a big impact on your quality of life, and you should not see it as an alternative to regular joint care. The good news is, you can protect your joints from becoming severely damaged by following the self-management techniques discussed in this program. This way, you’ll be preventing bleeds that cause severe damage in the first place.