Introduction: Thalassemic arthropathy refers to the spectrum of joint-related complications observed in individuals with thalassemia, a genetic blood disorder characterized by abnormal hemoglobin synthesis. There is sparse literature comparing the effects of repeated blood transfusions and chelation therapy on bone and joint health in these patients. Hence, we conducted a prospective observational study to see the prevalence of thalassemic arthropathy symptoms in transfusion dependent β-Thalassemia (TDBT) patients. Materials and methods: A total of 105 TDBT patients were evaluated over a 1-year period for the occurrence of arthralgia, swelling, restriction of joint range of motion, and soft tissue contractures. Our study was divided into two groups: TDBT patients on blood transfusions only (group I) (n = 58) and TDBT patients on blood transfusions and iron chelation therapy with deferiprone (L₁) (group II) (n = 47). The patients also underwent a radiological evaluation to detect evidence of joint space narrowing or arthritis. Results: Arthropathy was more common in group II (chelated) patients than group I (nonchelated) patients, and the correlation was statistically significant (p = 0.039); however, there was no statistical correlation between arthropathy and age; gender; age at initiation of transfusion therapy; pretransfusion hemoglobin status or the thalassemia subtype. Soft tissue contractures were more common in the arthropathy group than in those without arthropathy, and the difference was statistically significant (p = 0.041). There was no statistically significant correlation between soft tissue contractures and age, sex, age at first transfusion or thalassemia subtype. Discussion: Patients with TDBT receiving transfusions from an early age should be followed up regularly to diagnose musculoskeletal manifestations in the early stages when they can be reversed. Management of such patients requires a multidisciplinary approach involving the hematologist, rheumatologist, and orthopedic surgeons to diagnose thalassemic arthropathy before irreversible joint changes set in.