From 1984 to 1992, four hemophilic patients received total knee arthroplasty (TKA) in our hospital. The follow-up period was from one and a half years to eight years. Synovectomy was done concomitantly in all patients. Peri-operative clotting factor replacement therapy was used to control peri-operative bleeding. Cementless fixation was attempted for most prosthetic components, and bone graft was used in some patients. After the arthroplasty, pain relief was quite remarkable and the requirement for replacement therapy was reduced . However, the range of motion of the involved joint did not increased significantly. The operation-relative complication included revision of femoral component in one case and extension contracture in another case. Total knee arthroplasty is an appropriate procedure for patients with severe hemophilic arthropathy and the operation should be performed before the establishment of fixed contracture and joint deformity.