Background <p>Musculoskeletal complications remain common in people with severe hemophilia A (PwsHA) despite advances in medical treatment. Joint damage, pain, and functional limitations may affect health-related quality of life (QoL). This study aimed to evaluate QoL in PwsHA and examine associations of joint health, pain severity, dynamic balance, and fall history with QoL.</p> Methods <p>Thirty-six PwsHA participated in this cross-sectional study. QoL was assessed using the adult version of the Haemophilia-Specific Quality of Life Questionnaire. Joint health was evaluated using the Hemophilia Joint Health Score, pain severity using the Numeric Pain Rating Scale, and dynamic balance using the Limits of Stability test on a computerized posturography platform. Fall history was recorded as the self-reported number of falls during the previous 12 months. Correlations examined relationships between variables, and multiple linear regression identified factors independently associated with QoL.</p> Results <p>QoL analyses were completed for 35 participants (mean age 29.9 ± 9.4 years). Joint health, pain and dynamic balance showed a moderate correlation with QoL (<i>r</i> = 0.378, <i>p</i> = 0.30; <i>r</i> = 0.438, <i>p</i> = 0.011; <i>r</i> = − 0.35, <i>p</i> = 0.046, respectively). Fall history was not significantly correlated with QoL. However multiple regression analysis including joint health, pain, and dynamic balance did not identify a statistically significant model for explaining QoL.</p> Conclusions <p>Joint health impairment, pain severity, and dynamic balance performance were associated with QoL in PwsHA. These findings support comprehensive musculoskeletal assessment including balance evaluation to help identify potential targets for rehabilitation interventions in this population.</p> Trial registration <p>The study protocol was registered at ClinicalTrials.gov (NCT07523399) on 04/04/2026.</p>