Geniculate Artery Embolization in the Management of Spontaneous Recurrent Hemarthrosis of the Knee: Case Series

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

“…Other limitations include the relatively short followup (minimum of 1 year), which leaves open the possibility that these hemarthroses can recur, and the heterogeneity of the patient population in terms of diagnoses and presentations, which are typical of the condition, in our experience. During the last decade, case reports and other series reported satisfying results after transarterial embolization [1,3,5,7,9]. We found that transarterial embolization was well-tolerated and effective in six of seven patients; this tends to confirm and extend that experience.…”

“…The timing is variable, occurring from days to years after the index arthroplasty, as we observed and as prior studies have suggested [6,10]. Initial management usually is nonoperative, but for patients whose hemarthrosis recurs, and who do not have a treatable coagulopathy, more-invasive options include arthroscopic or open synovectomy, revision arthroplasty, and transarterial embolization [1,3,9]. Waldenberger et al [11] evaluated this method, but they did not focus on patients with joint replacements with longer followups.…”

“…Bagla et al [1], in a study on geniculate artery embolizations in five patients, reported two cases of transient cutaneous ischemia. Compared with the literature, our study showed a similar technical and clinical success rate of 100% in all patients without known coagulopathy.…”

“…Although the incidence is greater in patients with coagulopathy, bleeding from hypertrophic vascular synovium is assumed to be the likeliest mechanism [1,8]. Other causes are pseudoaneurysm formation, arteriovenous fistula, and pigmented villonodular synovitis of the knee [4,8].…”

“…More-invasive options include angiography with embolization, arthroscopic or open synovectomy, and revision arthroplasty [1,3,9]. However, because the condition is rare, seldom reported, and debilitating, small case series characterizing the efficacy of any approach are important to allow a collective experience with this condition to emerge.…”