Hemophilic pseudotumor is a rare, but well-known, complication of hemophilia. We 
describe a 50-year-old man with mild hemophilia A, but with no previous need for 
Factor VIII supplementation, who presented with a pathologic fracture of the 
right femoral neck and shaft caused by a large hemophilic pseudotumor. Initial 
nonoperative therapy with factor replacement and skeletal traction resulted in 
radiographic evidence of fracture healing, but the patient's pain persisted. 
Therefore, he had a radical resection of his hemophilic pseudotumor (soft tissue 
component and entire femur), and reconstruction with a custom total femoral 
replacement. Six months after resection, the patient returned to full-time 
employment. Although pseudotumor formation is a well-recognized complication of 
hemophilia, the pseudotumor in our study is one of the largest yet described. 
More importantly, to our knowledge this is the first report of a pseudotumor 
treated by radical resection and reconstruction with a custom femoral 
prosthesis. We think that radical resection and reconstruction with a custom 
total femoral prosthesis is a valuable alternative to amputation in massive 
pseudotumors of the femur and soft tissues of the thigh.