objective ：To explore the surgical treatment and perioperative management strategy of advanced hemophiliac arthritis (hip, knee and ankle joint). Methods ：From June 2010 to July 2018, 18 patients with advanced hemophiliac arthritis were treated. There were 16 cases of hemophilia A and 2 cases of hemophilia B. Their symptoms are pain, deformity and limited movement of the lower limb weight-bearing joints. Total knee arthroplasty was performed in 10 cases (12 knees), total hip arthroplasty in 4 cases (5 hips) and ankle arthrodesis in 4 cases (4 ankles). Tranexamic acid and coagulation factor replacement therapy were used to control perioperative blood loss in patients with hemophilia, and intraoperative blood loss and postoperative drainage were observed. HSS score of knee joint, Harris score of hip joint and Kofoed score of ankle joint were used to evaluate the curative effect of knee, hip and ankle joint surgery, and the complications were recorded. Results : The amount of bleeding during hip replacement was about 1000 ml, during knee surgery was about 710 ml, and during ankle surgery was about 310 ml. No serious life-threatening bleeding occurred in all cases. All of the cases were followed up for an average period of 30 months（range，5-60months）.The average HSS score increased from 47 preoperatively to 84 at the last follow up，the average Harris score increased from 42 to 88 ，and the average Kofoed score increased from 33 to 70.At the early postoperative stage，1 case of hematoma and 1 case of wound healing occurred，without joint infections or deep venous thrombosis .Bone fusion was achieved in all ankle joints，No loosening or dislocation of knee and hip prosthesis occurred in the late stage after operation. Conclusion: Surgical treatment of advanced hemophiliac arthritis is difficult and bleeding more, but combined use of tranexamic acid and coagulation factor replacement therapy can ensure the safety of bleeding, with careful operation during the operation and cooperation of relevant departments during the perioperative period, satisfactory results can be obtained after operation.