Unless the orthopedic surgeon is a core team member and is in frequent communication with the rest of the hemophilia team, the physiotherapist may also need to function as a ‘translator’ between the surgeon and the hematologists and nurses: what does the surgery involve, what does this mean for coagulation therapy during and after the surgery, how long will the sutures remain intact, what are the complications to watch for, etc. A. L. Forsyth Even with the continued advancements in practice, in terms of preventing and treating bleeding episodes, arthropathy persists as a complication in persons with hemophilia (PWH) and PWH with inhibitors (PWHWI). It has been reported

that PWHWI will likely have a greater degree of arthropathy, greater difficulties with mobility and significantly more joint pain [12]. Progression

5-Fluoracil nmr of arthropathy to a painful, severe stage can be an indication for EOS to address resultant pain and functional limitations. Although it is not without challenges and requires careful planning, EOS is fairly common in PWH in countries where it is available. EOS has been previously limited in PWHWI due to the potential risk of uncontrolled bleeding [13,14]. However, EOS is increasingly being performed in PWHWI [13–17] with the use of bypassing agents in comprehensive hemophilia treatment centers (HTCs). In both instances, it is important that PWH and PWHWI are cared for by medical professionals who understand the fundamental differences MAPK inhibitor in the treatment particularities of PWH and PWHWI versus working with patients in the general this website population who are undergoing these EOS procedures. The physiotherapist is an

integral member of the comprehensive, multidisciplinary HTC team, for the PWH and the PWHWI, involved during the planning through recovery phases, and can provide valuable intervention during all stages. Unfortunately, not all HTCs have a dedicated physiotherapist and, therefore, may consider referring patients to the hospital physiotherapy department or community physiotherapist for treatment. Additionally, if a HTC does have an experienced physiotherapist on their team, due to the rarity of PWHWI, they may not yet have accrued enough experience in working with this subgroup of bleeding-disorders clients. In general, physiotherapists who are experienced in working with orthopedic patients commonly treat patients before and after EOS. However, the type of treatment provided to a PWH and a PWHWI can be very different from that of a patient in the general population. Standard physiotherapy treatment approaches could prove hazardous and pose threats in terms of increased musculoskeletal bleeding complications and delayed wound healing, in PWH [18–19]. In turn, these complications can lead to more serious problems such as infection, loss of the prosthesis and even amputation [20].