Musculoskeletal problems of people with hemophilia aged > 65 years

Both the health-related quality of life and total life expectancy of people with hemophilia (PWH) have improved in recent decades.This can be attributed mostly to advancements in replacement therapy, antiviral medications, and improvements in global inclusive care rendered by the increasing number of multi-disciplinary specialized centers.The purpose of this article was to analyze what the literature reveals about the musculoskeletal problems of PWH aged > 65 years.For this narrative review of the literature, a search was conducted on PubMed and The Cochrane Library.It has been found that progressive hemophilic arthropathy and declining fitness in PWH aged > 65 risks loss of independence, falls and fractures.Additionally, hemophilic arthropathy is an important cause of pain and disability.It is a frequent indication for surgical intervention in PWH aged > 65 years.However, hemophilia per se is not a contraindication for emergency orthopedic surgery in PWH aged > 65 years.PWH aged > 65 years are at elevated risk of postoperative hemorrhage, which might be increased in individuals with coagulation abnormalities or thrombocytopenia due to liver cirrhosis from previous hepatitis C infection.In immunocompromised individuals with human immunodeficiency virus, there is an elevated risk of infection and prosthetic loosening.In conclusion, hemophilic arthropathy and fractures of PWH aged > 65 years should be treated similarly to their peers without hemophilia, with the addition of factor replacement therapy as appropriate.Prevention of falls is paramount.Major orthopedic surgery should be managed by multidisciplinary teams at Hemophilia Treatment Centers.