Introduction: Prophylaxis is standard of care in severe haemophilia of children and adolescents, its impact on health and quality of life, being demonstrated also in adults. As the replacement factors are representing about 90% of all costs, the individualization of therapy could be of utmost importance.

SummaryClinical expression of inadequately treated haemophilia is dominated by orthopedic complications, requiring invasive or non-invasive interventions. Objective: In Romania, with under dosed and late introduced “on demand” substitution, we aimed at highlighting the experience of orthopedic treatment and its outcome. Patients, methods: Single center retrospective analysis regarding orthopedic interventions and their outcomes was conducted on 59 hemophilia A, B, and von Willebrand disease patients, between 2002 and 2007. Results: The majority of interventions, invasive (60.71%) and non-invasive (39.28%), were elective, only two being emergencies. Postoperative functional evolution after synovectomies was good in 68.28%, fair in 24.39%, satisfactory in 7.31%. Results of 33 non-invasive (extensive releases) procedures were very good in 27.27%, good in 63.63%, poor in 9.09%. Discussion, conclusions: The important number and complexity of orthopedic interventions are proving the precarious musculoskeletal state in persons with hemophilia, demonstrating the need of improving substitution, at least with discontinue prophylaxis in patients with severe forms.