Go to the page content

Rafael lives in Mexico and has Haemophilia A

Elective Orthopaedic Surgery (EOS) frequently asked questions

Q. Am I or a loved one eligible for elective orthopaedic surgery?

A. There are many criteria to evaluate who may be eligible for EOS. Depending on the level of pain and disability, plus the improvement expected from the intended surgical procedure, a decision will be reached between the haemophilia care team, the patient and their family. In people with haemophilia and inhibitors, a personal risk assessment based on patient medical history is also necessary.

Q. I have inhibitors, can I consider EOS?

A. Compared to people without inhibitors, people with inhibitors are at an increased risk of experiencing bleeding episodes and often have a higher level of joint damage and so a lower quality of life that may necessitate elective orthopaedic surgery.

Although patients with inhibitors have an increased risk of bleeding during the perioperative period, advances in our knowledge and experience of haemostatic agents that can control bleeding during surgery have made elective orthopaedic surgery a viable option. Surgery (orthopaedic and non-orthopaedic) is now possible in haemophilia patients with inhibitors, leading to an improved quality of life for these patients.

Q. What type of anaesthesia will I receive?

A. Depending on the type of surgery, you and your anaesthesia team will determine the type of anaesthesia that is best for you. You may be fully asleep throughout the procedure (general anaesthesia) or be awake with only certain body parts anaesthetised (local anaesthesia).

Q. Are patients infected with Human Immunodeficiency Virus (HIV) and/or Hepatitis C Virus (HCV) eligible for surgery?

A. If you are seropositive for HIV and/or HCV and are experiencing painful arthritis and a reduced quality of life, your haematologist and multidisciplinary team may consider performing EOS to relieve the pain and improve your quality of life. Due to a higher complication rate and a post-operative risk of infection, your overall immunological status and your age should always be taken into account when making a decision to performing EOS.

Q. How long does a full EOS procedure will take?

A. The type of EOS will determine how long the procedure will take; however most procedures are no longer than a couple of hours. A total joint replacement (arthroplasty) will take around 2 hours; however, the patient will be required to stay in hospital for around 2 weeks, potentially longer. Some surgeries can take even less time, for example a surgical synovectomy usually takes 60–90 minutes and would require you to stay in hospital for a few days or weeks.

Q. If I consider EOS, what should I say to my employer/or school teachers?

A. If you are considering EOS then you will need to be aware of the time needed for recovery. Some surgeries will require you to be in hospital for days to weeks and will require physiotherapy and rehabilitation. Your haemophilia nurse will be able to help you with getting a doctor’s certificate to show your employer/education institution. If you have a smart phone, scan the relevant QR code below to access downloadable sheets to help in your discussions with your employer/education institution. You can print off the sheets by visiting the web addresses on a computer, or from your phone.

  • Novo Nordisk, EOS in People with Haemophilia, 2013
  • Raffini L, et al. Br J Haematol. 2007;136:777-787
  • Morfini M, et al. Haemophilia. 2007;13:606-612
  • Hoots WK. Semin Hematol. 2008;45(Suppl 1):S42-49
  • Teitel JM, et al. Haemophilia. 2009;15:227-239
  • Rodriguez-Merchan EC, et al. Haemophilia. 2010;16:84-88
  • Rodriguez-Merchan EC. Haemophilia. 2006;12 Suppl 3:90-101
  • Srivastava A, et al. Haemophilia. 2020;26 Suppl 6:1-158
  • Hanley J, et al. Haemophilia. 2017;23:511-520
  • Escobar MA et al. Haemophilia. 2018;24:693-702

Related pages

Getting ready for surgery

Getting ready for surgery

Learn about the role of the healthcare team and the role they play when preparing for surgery.

This material is for educational and informative purposes only. It should not replace any advice or information provided by your haemophilia specialist and/or other healthcare professionals. Surgery in patients with haemophilia (with or without inhibitors) can carry specific risks that should be carefully assessed and discussed with your haemophilia specialist and multidisciplinary care team. Surgery in patients with haemophilia (with or without inhibitors) should always be done in consultation with a specialised haemophilia treatment centre.