Hemarthrosis is a condition that occurs as a result of bleeding into a joint cavity.

A joint that has recurring hemarthrosis (bleeding episodes) is known as a target joint, which typically means that around four separate bleeds have occurred in the same joint over a 6-month period. However, a target joint can also be caused by one severe bleed.

The most common joints affected are the knees pain, ankles, and elbows, although it can also occur in the hip, shoulders, and wrists.

What is hemarthrosis ?

Joint bleeding is a common complication of hemophilia a genetic disorder that occurs when a clotting protein known as factor VIII or IX is defective or missing.

Over extended periods, excess bleeding can cause permanent damage in a persons joint, leading to reduced movement and sometimes, permanent disability.

The severity and frequency of the bleeds will determine how likely a person is to develop permanent damage.

Sometimes, a bleed into the joint space and the pressure caused by the blood filling the space can lead to severe pain, swelling, and deformity.

The damage caused by joint bleeding is similar to that of arthritis.

When bleeding occurs in the joint, it affects the cartilage that surrounds the bone. Cartilage prevents two bones that connect within a joint rubbing against each other when they move.

Joint bleeding destroys the cartilage, which erodes and becomes pitted. The damaged cartilage can no longer protect the bones from friction, so that they rub together, which is very painful. Over time, this will cause restricted movement in a persons joint.


The early signs that someone has a joint bleed leading to hemarthrosis include:

  • warmth in the joint
  • swelling in the joint
  • tingling in the joint
  • a baby with a bleeding joint may be irritable or crying for no reason that the parent can determine

Over time symptoms can become more serious and include :

  • the skin over the joint feels warm
  • swelling
  • stiffness
  • pain
  • loss of motion
  • discomfort
  • small children may refuse to straighten, use, or put weight on the affected limb


The treatment for hemarthrosis depends on the underlying cause of the joint damage and also how severe the damage is.

If another medical condition is causing the problem, then a doctor will need to diagnose and treat that separately.

Doctors can treat hemarthrosis, the pain, and the lack of movement associated with joint damage, with surgery.

If a person has hemophilia, they must discuss all surgery options thoroughly with a specialist blood doctor (hematologist) before they undergo any surgery.

However, most people with hemophilia take factor replacement therapy a medication to replace the defective or missing clotting protein which should prevent the hemarthrosis from happening in the first place.

There are two main types of surgery for treating hemarthrosis.


This procedure involves the removal of the synovium, which is the lining of a joint. The synovium helps lubricate the joint and also helps to remove any fluid and debris from the joint.

The synovium also contains blood vessels, which are the primary cause of any bleeding. Removing this lining stops the bleeding cycles.

A synovectomy will not make the joint 100 percent better, but it will help alleviate pain and improve movement.

There are three types of synovectomy:

  • Radioactive: A doctor injects a radioactive fluid into the joint.
  • Arthroscopic: A surgeon makes small incisions in the joint and removes the synovium, using a small camera for accuracy.
  • Open: Full surgery involves opening the joint completely to remove the synovium.

Joint replacement

Surgeons usually only carry out joint replacement surgery on people who have chronic, long-term pain that affects their daily life. During this procedure, a surgeon completely removes the damaged joint and bone and replaces them with plastic and metal components.

Surgeons carry out this procedure more often on people with knee and hip joint problems. After surgery and physiotherapy, a person who has had a joint replacement should feel no pain and experience improved movement.

90 percent of joint replacements last for 10 years.

Other types of surgery as treatment for joint pain include :

  • Cheilectomy: Removal of small bony growths on the joint.
  • Arthrodesis: Fusion of the joint.
  • Osteotomy: Removal of a piece of bone in the leg to straighten it and reduce pain.

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