BACKGROUND: Hemophilic pseudotumor (HPT) is a rare disease with many challenges. 
Only a few reports on surgical treatment for HPT have been published.
METHODS: The cases of 23 patients with HPT who had surgical treatment from July 
1996 to December 2014 were retrospectively reviewed. Demographic data, blood 
loss and transfusion during surgery, outcomes, and complications after surgery 
were analyzed.
RESULTS: Eleven patients underwent HPT resection; 4 underwent HPT excision, 
allograft transplantation, and absorbable screw fixation; 3 had HPT resection 
and metallic internal fixation; 2 had HPT resection, autogenous fibular 
grafting, and absorbable screw fixation; 2 underwent curettage and 
bone-grafting; and 1 patient received above-the-knee amputation. The average age 
(and standard deviation) of the patients at the time of surgery was 31.9 ± 12.8 
years (range, 6 to 54 years) with an average follow-up of 5.3 ± 4.7 years 
(range, 1.1 to 19.6 years). The median duration of the surgery was 157 minutes 
(range, 90 to 315 minutes). The median amount of blood loss during surgery was 
800 mL (range, 100 to 4,000 mL). Three patients (13%) had a postoperative 
infection, 2 (8.7%) had recurrence of HPT, and another 2 patients had fracture 
nonunion.
CONCLUSIONS: Surgical treatment of HPT with a modified protocol of coagulation 
factor replacement is safe and effective. It should be recommended for patients 
with HPT who have progressive enlargement of the mass, recurrent and massive 
bleeding, spontaneous perforation, bone erosion, or compression of surrounding 
tissues or who have had failure of conservative treatment.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a 
complete description of levels of evidence.