In the `prophylaxis era´ people with hemophilia still need major orthopedic surgery.

Introduction: A non-negligible percentage of people with hemophilia (PWH) eventually develop hemophilic arthropathy in what we might call the 'prophylaxis era'.

Areas covered: Due to hemophilic arthropathy, some of the patients suffering from it will eventually require major orthopedic surgery when conservative treatment has failed. The purpose of this article has been to analyze the articles published in PubMed during the period 2020-2025, in order to detect what type of major orthopedic surgery interventions are performed in PWH during the 'prophylaxis era'. On 22 April 202522 April 2025, using 'hemophilia orthopedic surgery' from 1 January 2020 to 22 April 2025 as keywords, 373 articles were found in PubMed. Of these, 50 were analyzed because they were directly related to the title of this article (inclusion criterion). The remaining 323 were excluded because they were not directly related to the title of this article.

Expert opinion: Although great progress has been made in prophylaxis therapy in PWH, some patients still suffer from severe painful and disabling hemophilic arthropathy requiring major orthopedic surgery. This suggests that there is still much room for improvement in prophylaxis therapy in PWH. Multidisciplinary teams treating PWH should redouble their efforts to eliminate hemophilic arthropathy.