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General Rehabilitation

From Bleed to Speed: Rehabilitation of a Hemophiliac’s Knee Hemarthrosis

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 1

    Co-Author(s)

  • KB

    Kevin Batti, MD

    Resident Physician
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

    • Poster Presenter(s)

  • Yolanda N. Pham, MD, MPH

    Resident Physician
    Montefiore Medical Center/Albert Einstein College of Medicine
    Bronx, New York

    • Co-Author(s)

  • Eathar A. Saad, MD (she/her/hers)

    Assistant Professor, Albert Einstein College of Medicine
    Montefiore Medical Center
    Tenafly, New Jersey

Disclosure(s):
Eathar A. Saad, MD: No financial relationships to disclose
Case Diagnosis: 24-year-old male with severe hemophilia B with recurrent hemarthroses causing joint degeneration, pain, and reduced mobility.

Case Description or Program Description: A 24-year-old male with severe hemophilia B (on Alprolix) and a prior right knee arthroscopy with synovectomy, debridement, and chondroplasty presented to clinic. He reported frequent hemarthroses in his elbows and knees with associated intermittent pain. He experienced bilateral knee bleeds after walking long distances and with exertion including running, but notes that his post-infusion gym sessions (including biking and treadmill) were bleed-free. Exam showed normal gait, slight right knee warmth, no effusion, and limited range of motion with pain at end-range. Special tests of the knees were negative.

Setting: Academic outpatient rehabilitation clinic.

Assessment/Results: This patient with severe hemophilia had recurrent hemarthroses and associated pain limiting ability to participate in physical activity. It is important to understand the unique rehabilitation management of hemophilia patients in order to address functional outcomes and improve overall physical health.

Discussion (relevance): Recurrent hemarthroses in hemophilia drive joint damage and disability. There are certain rehabilitation strategies to minimize bleeding and boost mobility, offering a practical approach for managing hemophilic arthropathy in young adults. It is important to include low-impact modalities (e.g., cycling and swimming) to strengthen periarticular muscles without joint stress, alongside proprioceptive exercises (e.g., balance board training) to enhance stability. Infusions of recombinant factor IX should be timed 30-60 minutes pre-exercise to maintain peak factor levels during activity, reducing bleed risk. High-impact exercises, such as running, jumping, and/or heavy weightlifting, should be avoided due to excessive joint loading and shear forces that exacerbate hemarthroses. Coordinated prophylaxis and tailored rehabilitation can mitigate bleeding while improving function in these patients.

Conclusions: Hemophilia rehabilitation should focus on joint protection, bleed prevention, and pain relief via individualized low-impact exercise and optimized prophylaxis.