Angiographic findings and therapeutic embolization of late hemarthrosis after total joint arthroplasty

Abstract

Angiography for late spontaneous hemarthrosis is very effective to exclude or establish vascular malformations and to establish the diagnosis of hypertrophic vascular synovium. Selective arterial embolization seems to be a good therapeutic option as alternative to open or arthroscopic synovectomy.

Is Embolization an Effective Treatment for Recurrent Hemorrhage After Hip or Knee Arthroplasty?

“…Spontaneous hemarthrosis after hip or knee arthroplasty is rare, but it can be painful and debilitating [2,3,10,11]. The timing is variable, occurring from days to years after the index arthroplasty, as we observed and as prior studies have suggested [6,10].…”

Embolisation for Vascular Injuries Complicating Elective Orthopaedic Surgery

“…Considerations for choosing an embolic agent are speed and reliability of delivery, duration of occlusion and preservation of normal tissue. 8,20,28,35,36 Coils are highly radiopaque, and ideal for single and large vessel occlusion. 18e20,25 Coils can be deployed as a strut and combined with gelatin sponge or particles as occlusion agents.…”

“…18e20,25 Coils can be deployed as a strut and combined with gelatin sponge or particles as occlusion agents. 28 The use of gelatin sponge alone has the disadvantage of temporary embolic effect; thus, recurrent bleeding may occur. 16,19,27 For multiple lesions and distal location, particles can be used.…”

“…However, particles are not radiopaque and penetrate deeper into the vascular system due to lower viscosity, thereby increasing the risk of ischaemic complications. 27,28 NBCA, 'liquid glue' is a liquid embolic agent that spreads according to its polymerisation time and vascular flow. NBCA does not permeate all the way to the capillary level, and therefore does not cause tissue death.…”

Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis

“…6,8 Because aspiration may not fully resolve a patient's symptoms, further management must be tailored to the potential underlying etiology of the hemarthroses. In the post-TKA setting, arthroscopic 6 and angiographic investigations 11 often reveal a hypertrophic synovium as the underlying mechanism, though other causes have been reported including: arteriovenous fistula of the geniculate vessels, 3 pseudoaneurysm of geniculate vessels, 27 angiosarcoma, 4 impingement of vascular structures under meniscal remnants, 2 and implant malposition. 27 It is pertinent for the surgeon faced with recurrent hemarthroses following TKA to thoroughly consider these various etiologies, as they may guide further management.…”