This case illustrates moderate-stage hemophilic arthropathy in an elderly patient who grew up with limited access to coagulation factor therapy, leading to progressive joint damage over decades. The patient shows significant structural joint changes with moderate functional impairment, yet retains some mobility and independence. The coexistence of hemophilia-related arthropathy and age-related osteoarthritis results in a complex clinical picture, with both erosive changes and osteophyte formation. Management is challenging because of multiple comorbidities, requiring avoidance of NSAIDs due to renal disease and bleeding risk. Treatment includes factor VIII prophylaxis (2000 IU three times weekly), scheduled acetaminophen, topical lidocaine, and low-dose tramadol for breakthrough pain. Physical therapy aims to preserve range of motion and strength through gentle exercises and aquatic therapy, and a custom ankle-foot orthosis is used to improve stability and reduce pain during ambulation. Surgical options are limited by age and comorbidities, though ankle arthrodesis may be considered if pain becomes refractory. Quality of life is a central focus, supported by a multidisciplinary approach, home safety modifications, and ongoing education on fall prevention.