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Escobar MA, Brewer A, Caviglia H, Forsyth A, Jimenez-Yuste V, Laudenbach L, Lobet S, McLaughlin P, Oyesiku JOO, Rodriguez-Merchan EC, Shapiro A, Solimeno LP. Recommendations on multidisciplinary management of elective surgery in people with haemophilia. Haemophilia 2018; 24:693-702. [PMID: 29944195 DOI: 10.1111/hae.13549] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/23/2022]
Abstract
Planning and undertaking elective surgery in people with haemophilia (PWH) is most effective with the involvement of a specialist and experienced multidisciplinary team (MDT) at a haemophilia treatment centre. However, despite extensive best practice guidelines for surgery in PWH, there may exist a gap between guidelines and practical application. For this consensus review, an expert multidisciplinary panel comprising surgeons, haematologists, nurses, physiotherapists and a dental expert was assembled to develop practical approaches to implement the principles of multidisciplinary management of elective surgery for PWH. Careful preoperative planning is paramount for successful elective surgery, including dental examinations, physical assessment and prehabilitation, laboratory testing and the development of haemostasis and pain management plans. A coordinator may be appointed from the MDT to ensure that critical tasks are performed and milestones met to enable surgery to proceed. At all stages, the patient and their parent/caregiver, where appropriate, should be consulted to ensure that their expectations and functional goals are realistic and can be achieved. The planning phase should ensure that surgery proceeds without incident, but the surgical team should be ready to handle unanticipated events. Similarly, the broader MDT must be made aware of events in surgery that may require postoperative plans to be changed. Postoperative rehabilitation should begin soon after surgery, with attention paid to management of haemostasis and pain. Surgery in patients with inhibitors requires even more careful preparation and should only be undertaken by an MDT experienced in this area, at a specialized haemophilia treatment centre with a comprehensive care model.
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Affiliation(s)
- M A Escobar
- McGovern Medical School and the Gulf States Hemophilia and Thrombophilia Center, University of Texas Health Science Center, Houston, TX, USA
| | - A Brewer
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - H Caviglia
- Orthopedics and Traumatology Department, "Juan A. Fernandez" Hospital, Buenos Aires, Argentina
| | - A Forsyth
- REBUILD Program/Diplomat Specialty Infusion Group, Cincinnati, OH, USA
| | - V Jimenez-Yuste
- Department of Haematology, La Paz University Hospital - IdiPaz, Madrid, Spain
| | - L Laudenbach
- London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - S Lobet
- Haemostasis and Thrombosis Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - P McLaughlin
- Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK
| | - J O O Oyesiku
- Haemophilia, Haemostasis and Thrombosis Centre, Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - E C Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital - IdiPaz, Madrid, Spain
| | - A Shapiro
- Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA
| | - L P Solimeno
- IRCCS Cà Granda Foundation, Maggiore Hospital of Milan, Milan, Italy
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Deschamps K, Staes F, Eerdekens M, Peerlinck K, Hermans C, Vandesande J, Lobet S. Postural control during a transition task in haemophilic children, adolescents and young adults with haemophilic ankle arthropathy. Haemophilia 2018; 24:667-674. [DOI: 10.1111/hae.13484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 11/27/2022]
Affiliation(s)
- K. Deschamps
- Department of Rehabilitation Sciences; Musculoskeletal Rehabilitation Research Group; KULeuven; Leuven (Heverlee) Belgium
- Division of Podiatry; Institut D'Enseignement; Supérieur Parnasse Deux-Alice; Sint-Lambrechts-Woluwe Belgium
- Department of Podiatry; Artevelde University College; Ghent Belgium
- Department of Physical Medicine; University Hospitals Leuven; Pellenberg Belgium
| | - F. Staes
- Department of Rehabilitation Sciences; Musculoskeletal Rehabilitation Research Group; KULeuven; Leuven (Heverlee) Belgium
| | - M. Eerdekens
- Department of Physical Medicine; University Hospitals Leuven; Pellenberg Belgium
| | - K. Peerlinck
- Department of Cardiovascular Sciences; Centre for Molecular and Vascular Biology; KULeuven; Leuven Belgium
| | - C. Hermans
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Bruxelles Belgium
| | - J. Vandesande
- Department of Cardiovascular Sciences; Centre for Molecular and Vascular Biology; KULeuven; Leuven Belgium
| | - S. Lobet
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Bruxelles Belgium
- Secteur des Sciences de la Santé; Institut de Recherche Expérimentale et Clinique; Neuromusculoskeletal Lab (NMSK); Université catholique de Louvain; Brussels Belgium
- Service de médecine physique et réadaptation; Cliniques universitaires Saint-Luc; Brussels Belgium
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3
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Lobet S, Cartiaux O, Peerlinck K, Henrard S, Hermans C, Detrembleur C, Deschamps K. Assessment of passive musculoarticular ankle stiffness in children, adolescents and young adults with haemophilic ankle arthropathy. Haemophilia 2018; 24:e103-e112. [PMID: 29600577 DOI: 10.1111/hae.13467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To measure passive musculoarticular ankle stiffness (PMAAS) and its intra- and interday reliability in adult control subjects without ankle disorders. We also sought to quantify PMAAS in children, adolescents and young adults with haemophilia (CAAwH) taking into account the accurate tibiotalar and subtalar joints structural status obtained by magnetic resonance imaging (MRI). METHODS We included 23 CAAwH and 23 typically developing boys (TDB) matched by age, weight and height, along with 25 healthy volunteers for reliability assessment. All CAAwH underwent bilateral ankle MRI, with anatomical status assessed using the International Prophylaxis Study Group MRI scale. All CAAwH underwent PMAAS testing for both sides randomly vs the dominant side (DS) in TDBs. For assessing viscous stiffness (VS) and elastic stiffness (ES), eight different oscillation frequencies were randomly repeated three times for each subject. RESULTS Good-to-excellent intra- and interday reliability was observed for ES and VS variables. No relevant differences were observed between the ankle viscoelastic properties in CAAwH without joint damage and matched TDBs, whereas the study revealed significantly increased ES in the affected ankles of CAAwH with severe unilateral joint involvement compared to the non-affected joint. CONCLUSION This study confirmed increased ES in the severely affected ankles of CAAwH compared to non-affected sides. No differences in the ankle viscoelastic properties of CAAwH with or without joint damage were observed, however, compared to matched TDB.
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Affiliation(s)
- S Lobet
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Service d'hématologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - O Cartiaux
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - K Peerlinck
- Centre for molecular and vascular biology, KU Leuven, Leuven, Belgium
| | - S Henrard
- Clinical pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Institute of health and society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - C Hermans
- Service d'hématologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - C Detrembleur
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - K Deschamps
- Department of rehabilitation sciences, Musculoskeletal rehabilitation research group, KU Leuven, Leuven (Heverlee), Belgium.,Department of podiatry, Artevelde University college, Ghent, Belgium.,Department of podiatry, Parnasse-ISEI, Haute École Leonard de Vinci, Brussels, Belgium
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Brunel T, Lobet S, Deschamps K, Hermans C, Peerlinck K, Vandesande J, Pialat JB. Reliability and clinical features associated with the IPSG MRI tibiotalar and subtalar joint scores in children, adolescents and young adults with haemophilia. Haemophilia 2017; 24:141-148. [DOI: 10.1111/hae.13368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- T. Brunel
- Department of Radiology; Hôpital de la Croix-rousse; Hospices Civils de Lyon; Lyon France
| | - S. Lobet
- Secteur des Sciences de la Santé; Institut de Recherche Expérimentale et Clinique; Neuromusculoskeletal Lab (NMSK); Université Catholique de Louvain; Brussels Belgium
- Cliniques Universitaires Saint-Luc; Service d'hématologie; Brussels Belgium
- Cliniques Universitaires Saint-Luc; Service de médecine physique et réadaptation; Brussels Belgium
| | - K. Deschamps
- Department of Rehabilitation Sciences; Musculoskeletal Rehabilitation Research Group; KU Leuven; Leuven Belgium
- Laboratory for Clinical Motion Analysis; University Hospital Pellenberg; UZ Leuven; Leuve Belgium
- Department of Podiatry; Parnasse-ISEI; Brussels Belgium
- Department of Podiatry; Artevelde University College Ghent; Ghent Belgium
| | - C. Hermans
- Cliniques Universitaires Saint-Luc; Service d'hématologie; Brussels Belgium
| | - K. Peerlinck
- Department of Cardiovascular sciences; KULeuven; Leuven Belgium
- Haemophilia Center; University Hospitals Leuven; Leuven Belgium
| | - J. Vandesande
- Haemophilia Center; University Hospitals Leuven; Leuven Belgium
| | - J.-B. Pialat
- Department of Radiology; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre-Bénite France
- Université Claude Bernard Lyon 1; Université de Lyon; Lyon France
- INSERM; UMR 1033 LYOS; Lyon France
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Lobet S, Croisier JL, Lantin AC, Hermans C, Peerlinck K, Vandesande J, Pialat JB, Deschamps K. Deficits of ankle muscle strength not found in children, adolescents and young adults with haemophilic ankle arthropathy. Haemophilia 2017; 23:e409-e418. [DOI: 10.1111/hae.13274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 12/25/2022]
Affiliation(s)
- S. Lobet
- Secteur des Sciences de la Santé; Institut de Recherche Expérimentale et Clinique; Neuromusculoskeletal Lab (NMSK); Université catholique de Louvain; Brussels Belgium
- Service d'hématologie; Cliniques universitaires Saint-Luc; Brussels Belgium
- Service de médecine physique et réadaptation; Cliniques universitaires Saint-Luc; Brussels Belgium
| | - J.-L. Croisier
- Department of motricity and rehabilitation sciences; University and CHU of Liège; Liège Belgium
| | - A.-C. Lantin
- Comité d’Éthique Biomédicale Hospitalo-Facultaire UCL; Bruxelles Belgium
| | - C. Hermans
- Service d'hématologie; Cliniques universitaires Saint-Luc; Brussels Belgium
| | - K. Peerlinck
- Centre for molecular and vascular biology; KU Leuven; Leuven Belgium
| | - J. Vandesande
- Centre for molecular and vascular biology; KU Leuven; Leuven Belgium
| | - J.-B. Pialat
- Centre Hospitalier Lyon Sud; Service de Radiologie; Hospices Civils de Lyon; Pierre-Bénite France
- Université Claude Bernard Lyon 1; Université de Lyon; Lyon France
- LYOS INSERM UMR 1033; Lyon France
| | - K. Deschamps
- KU Leuven; Department of rehabilitation sciences; Musculoskeletal rehabilitation research group; Leuven Belgium
- Department of Podiatry; Artevelde University College; Ghent Belgium
- Department of Podiatry; Parnasse-ISEI; Haute Ecole Leonard de Vinci; Brussels Belgium
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Lobet S, McCarthy A, Hermans C, Peerlinck K, Matricali GA, Staes F, Deschamps K. Biomechanical markers and theoretical concepts related to haemophilic ankle and subtalar joint arthropathy: introducing the term ‘haemophilic tarsal pan-arthropathy’. Haemophilia 2017; 23:e250-e258. [DOI: 10.1111/hae.13202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 12/22/2022]
Affiliation(s)
- S. Lobet
- Secteur des Sciences de la Santé; Institut de Recherche Expérimentale et Clinique; Computer Assisted Robotic Surgery (CARS); Université catholique de Louvain; Brussels Belgium
- Cliniques universitaires Saint-Luc; Service d'hématologie; Brussels Belgium
- Cliniques universitaires Saint-Luc; Service de médecine physique et réadaptation; Brussels Belgium
| | - A. McCarthy
- Katharine Dormandy Haemophilia & Thrombosis Centre; Royal Free Hospital; London UK
| | - C. Hermans
- Cliniques universitaires Saint-Luc; Service d'hématologie; Brussels Belgium
| | - K. Peerlinck
- Centre for Molecular and Vascular Biology; KU Leuven; Leuven Belgium
| | - G. A. Matricali
- Department of Development & Regeneration; KU Leuven; Leuven Belgium
- Department of Orthopaedics; Foot & Ankle Unit; University Hospitals Leuven; KU Leuven; Leuven Belgium
- Institute of Orthopaedic Research & Training; KU Leuven; Leuven Belgium
| | - F. Staes
- Department of Rehabilitation Sciences; Musculoskeletal Rehabilitation Research Group; KU Leuven; Leuven Belgium
| | - K. Deschamps
- Department of Rehabilitation Sciences; Musculoskeletal Rehabilitation Research Group; KU Leuven; Leuven Belgium
- Department of Podiatry; Artevelde University College; Ghent Belgium
- Department of Podiatry; Parnasse-ISEI; Haute Ecole Leonard de Vinci; Bruxelles Belgium
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Lobet S, Lambert C, Hermans C. Stop only advising physical activity in adults with haemophilia… prescribe it now! The role of exercise therapy and nutrition in chronic musculoskeletal diseases. Haemophilia 2016; 22:e554-e556. [DOI: 10.1111/hae.13073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 12/31/2022]
Affiliation(s)
- S. Lobet
- Secteur des Sciences de la Santé; Institut de Recherche Expérimentale et Clinique; Computer Assisted Robotic Surgery (CARS); Université Catholique de Louvain; Brussels Belgium
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Brussels Belgium
- Service de médecine physique et réadaptation; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - C. Lambert
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - C. Hermans
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Brussels Belgium
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Astermark J, Dolan G, Hilberg T, Jiménez-Yuste V, Laffan M, Lassila R, Lobet S, Martinoli C, Perno CF. Managing haemophilia for life: 4th Haemophilia Global Summit. Haemophilia 2015; 20 Suppl 5:1-20. [PMID: 24924596 DOI: 10.1111/hae.12468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The 4th Haemophilia Global Summit was held in Potsdam, Germany, in September 2013 and brought together an international faculty of haemophilia experts and delegates from multidisciplinary backgrounds. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored global perspectives in haemophilia care, discussing practical approaches to the optimal management of haemophilia now and in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance and potential to influence haemophilia care globally. In this supplement from the meeting, Jan Astermark reviews current understanding of risk factors for the development of inhibitory antibodies and discusses whether this risk can be modulated and minimized. Factors key to the improvement of joint health in people with haemophilia are explored, with Carlo Martinoli and Víctor Jiménez-Yuste discussing the utility of ultrasound for the early detection of haemophilic arthropathy. Other aspects of care necessary for the prevention and management of joint disease in people with haemophilia are outlined by Thomas Hilberg and Sébastian Lobet, who highlight the therapeutic benefits of physiotherapy and sports therapy. Riitta Lassila and Carlo-Federico Perno describe current knowledge surrounding the risk of transmission of infectious agents via clotting factor concentrates. Finally, different types of extended half-life technology are evaluated by Mike Laffan, with a focus on the practicalities and challenges associated with these products.
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Affiliation(s)
- J Astermark
- Department of Hematology and Vascular Disorders, Skåne University Hospital, Malmö/Lund, Sweden
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Negrier C, Seuser A, Forsyth A, Lobet S, Llinas A, Rosas M, Heijnen L. The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity. Haemophilia 2013; 19:487-98. [DOI: 10.1111/hae.12118] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2013] [Indexed: 01/29/2023]
Affiliation(s)
- C. Negrier
- Unité d'Hémostase Clinique; Centre Régional de Traitement de l'Hémophilie; Lyon; France
| | | | - A. Forsyth
- Christiana Care Health System Hemophilia Program; Newark; DE; USA
| | - S. Lobet
- Haemostasis and Thrombosis Unit; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain; Brussels; Belgium
| | - A. Llinas
- Department of Orthopedics and Traumatology; Fundación Santa Fe de Bogotá; University Hospital and Universidad de los Andes; School of Medicine; Bogotá; Colombia
| | - M. Rosas
- National Hemophilia Center; Banco Metropolitano de Sangre DC; Caracas; Venezuela
| | - L. Heijnen
- Van CreveldKliniek; UMC; Utrecht and Rehabilitation Centre De Trappenberg; Huizen; The Netherlands
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Lobet S, Detrembleur C, Hermans C. Impact of multiple joint impairments on the energetics and mechanics of walking in patients with haemophilia. Haemophilia 2012; 19:e66-72. [DOI: 10.1111/hae.12001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 01/03/2023]
Affiliation(s)
| | - C. Detrembleur
- Institute of Neuroscience IoNS; Université Catholique de Louvain; Brussels; Belgium
| | - C. Hermans
- Haemostasis and Thrombosis Unit; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels; Belgium
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Hermans C, Hammer F, Lobet S, Lambert C. Subclinical deep venous thrombosis observed in 10% of hemophilic patients undergoing major orthopedic surgery. J Thromb Haemost 2010; 8:1138-40. [PMID: 20180819 DOI: 10.1111/j.1538-7836.2010.03829.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
As haemophilic arthropathy and chronic synovitis are still the most important clinical features in people with haemophilia, different kinds of invasive and orthopaedic procedures have become more common during the last decades. The availability of clotting factor has made arthroplasty of one, or even multiple joints possible. This article highlights the role of physiotherapy before and after such procedures. Synovectomies are sometimes advocated in people with haemophilia to stop repetitive cycles of intra-articular bleeds and/or chronic synovitis. The synovectomy itself, however, does not solve the muscle atrophy, loss of range of motion (ROM), instability and poor propriocepsis, often developed during many years. The key is in taking advantage of the subsequent, relatively safe, bleed-free period to address these important issues. Although the preoperative ROM is the most important variable influencing the postoperative ROM after total knee arthroplasty, there are a few key points that should be considered to improve the outcome. Early mobilization, either manual or by means of a continuous passive mobilization machine, can be an optimal solution during the very first postoperative days. Muscle isometric contractions and light open kinetic chain exercises should also be started in order to restore the quadriceps control. Partial weight bearing can be started shortly after, because of quadriceps inhibition and to avoid excessive swelling. The use of continuous clotting factor replacement permits earlier and intensive rehabilitation during the postoperative period. During the rehabilitation of shoulder arthroplasty restoring the function of the rotator cuff is of utmost importance. Often the rotator cuff muscles are inhibited in the presence of pain and loss of ROM. Physiotherapy also assists in improving pain and maintaining ROM and strength. Functional weight-bearing tasks, such as using the upper limbs to sit and stand, are often discouraged during the first 6 weeks postoperatively. This may be influenced by the condition of the joints of the lower limbs. Attention should be given to the total chain of motion, of which the shoulder itself is only a part. We conclude that physiotherapy management is of major importance in any invasive or orthopaedic procedure, regardless of which joints are involved. Both pre- and postoperative physiotherapy, as part of comprehensive care is needed to achieve optimal functional outcome and therefore optimal quality of life for people with haemophilia.
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