The joints most often affected Raf pathway are knees, ankles and elbows [7]. Although haemophilic arthropathy can be prevented by giving regular prophylaxis [8] and implementing physiotherapy programs [9], there is still a group of young adults who have a severe degree of knee joint destruction as a result of repeated articular bleeding

episodes during their early years. This is particularly true for the 80% of severe haemophiliacs who live in developing countries, where appropriate health resources are severely limited. In most of these countries, health insurance schemes are non-existent and where they do exist, they do not cover diseases such as haemophilia, which are expensive to treat. In this review, the role of surgical and non-surgical treatment of stiff knee and its complications will be described. Stiff knee is a common problem in people with haemophilia (PWH), especially in developing countries, due to various factors

such as lack of knowledge about haemophilia leading to delay in treatment of bleeds and paucity of factor replacement therapy. In such conditions, knee bleeds often get neglected and little boys continue to walk which causes repeated bleeds. Due to pain and swelling in the knee, they tend to hold their knees in the flexed position with the hips in external rotation. This commonly leads to flexion contractures at the knee. Valgus, external rotation deformity and posterior subluxation of the tibia may exist alongside Enzalutamide the knee flexion contracture [10]. Physiotherapy for stiff knees is most useful MCE in the early stages of contracture formation and has a greater role in preventing rather treating the formation of knee contractures. Physical therapy is usually more effective when combined with splintage and skin traction. Initial aims of therapy must be to correct/decrease the knee contracture, regain range of motion (ROM) in that knee, regain muscle power particularly in the quadriceps muscles, regain appropriate and timely recruitment of the quadriceps and hamstring muscles both during open chain movements and during the gait

cycle. Finally, the therapy programme must also look at functional restoration such as being able to sit, squat, kick a ball and negotiate stairs and ramps. Decision making depends on the duration and the severity of the contracture and the presence of articular subluxation or angulation deformities. The overall health of the patient’s musculoskeletal status will also affect outcome of conservative management of contractures. Factor cover is preferred but not absolutely necessary to undergo physical therapy for knee contractures except in the case of inhibitor patients. It is recommended to attend daily physical therapy sessions for these problems. Initial sessions should focus on pain relief and obtaining maximal voluntary contraction of the quadriceps.