Haemarthroses after total knee arthroplasty caused by an isolated platelet factor 3 availability defect

Malhotra, Rajesh; Bhan, Surya; Kiran, E. Krishna

doi:10.1302/0301-620x.87b11.16836

Cited by 12 publications

(11 citation statements)

References 31 publications

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“…Interestingly, defects in the availability of platelet factor 3 in some patients have been attributed to hemarthrosis. 18 Routine coagulation profi les were normal, and no patients showed recurrent hemarthrosis after platelet transfusion. 18 Furthermore, synoviorthesis by injection of 6.5 mCi of yttrium 90 into the knee joint to diminish the size of the proliferative synovium was a successful treatment.…”

Section: Discussionmentioning

confidence: 95%

Recurrent Hemarthrosis After Unicompartmental Knee Arthroplasty

Asanuma¹,

Itô²,

Ogawa³

et al. 2011

Orthopedics

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Recurrent hemarthrosis after knee arthroplasty can be disabling, requiring adequate and immediate diagnosis and treatment for recovery of symptoms and joint function. The most commonly reported cause is impingement of proliferative synovium between prosthetic components. Although various procedures for hemarthrosis have been reported after knee arthroplasty for patients who do not respond to conservative treatment, the recommended first-line therapy is open surgery or embolization. Although hyperplastic synovium was observed during the first and second arthrotomy, in our case, tissue impingement was not detected. We describe a rare case of recurrent hemarthrosis after unicompartmental knee arthroplasty (UKA) and successful treatment by open synovectomy. A 66-year-old woman presented with spontaneous osteonecrosis of the medial femoral condyle in the right leg. She underwent UKA of the right knee of the medial condyle. Eighteen months after UKA, the patient developed recurrent hemarthrosis. Open arthrotomy was performed 22 months after UKA, revealing only hematoma with no obvious hemorrhage or loosening of the prosthesis. No history of trauma or use of anticoagulant medications was present. After a symptom-free period of 8 months, another 2 episodes of hemarthrosis occurred over the course of 8 months. A second open arthrotomy was performed. Hyperplastic synovium with fibrin and hemosiderin pigmentation was observed, again without hemorrhage or loosening. There were no pathological features of pigmented villonodular synovitis. Synovectomy was performed, and no hemarthrosis has recurred for 2 years.

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Section: Discussionmentioning

confidence: 95%

Recurrent Hemarthrosis After Unicompartmental Knee Arthroplasty

Asanuma¹,

Itô²,

Ogawa³

et al. 2011

Orthopedics

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“…The most frequent reported causes of recurrent bleeding into the knee are entrapped proliferative synovial tissue or the fat pad caught between prosthetic components [9]. Other reported causes include tumors [3], retained meniscal fragments [7], pigmented villonodular synovitis [2], vascular causes (aneurysms, pseudoaneurysms, arteriovenous fistulae) [5,6,14,15,18], hematologic conditions [11], use of anticoagulants, or mechanical factors causing repetitive minor trauma such as malalignment, instability, and malposition of the implants [16]. In more than 50% of cases, no cause for bleeding is found [9].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Hemarthroses After TKA Treated With an Intraarticular Injection of Yttrium-90

Fine

Klestov

2016

Clinical Orthopaedics &Amp; Related Research

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Background Recurrent hemarthroses after a TKA are uncommon and usually respond to nonoperative treatment or intervention using angiographic embolization or synovectomy. However, in rare circumstances, the problem can be resistant to treatment. Case Description We report the case of a patient who had recurrent hemarthroses after a TKA. During the first 18 months after surgery, the patient experienced 48 episodes consistent with bleeding into the knee. The bleeding episodes recurred despite use of traditional treatments, including arthroscopy, open synovectomy and embolization of a small, false aneurysm. The patient ultimately received an intraarticular injection of yttrium-90 silica/citrate, and the hemarthroses ceased soon after the injection. At last review, 25 months after the injection, the patient had experienced no additional bleeding episodes. Literature Review On review of the literature, we found only one other report in which yttrium-90 was used successfully in a similar situation. Clinical Relevance Yttrium-90 may be considered a treatment option in patients with recurrent hemarthroses after TKA, especially when the condition has not responded to more traditional treatments. The long-term risk of treatment with yttrium-90 for recurrent hemarthroses after a TKA remains unclear.

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“…Of these, recurrent hemarthrosis is a relatively uncommon complication with a reported incidence of 0.1 to 1.6%. 1,2 The general causes of hemarthrosis after TKR are anticoagulant medication, hemophilia, 3 pigmented villo-nodular synovitis, 4 platelet factor-3 defect, 5 or medical illness. The local causes can be early or late.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent hemarthrosis is a rare complication after total knee replacement (TKR) with a reported incidence between 0.1 and 1.6%. 1,2 The general causes include anticoagulant medication, hemophilia, 3 pigmented villonodular synovitis, 4 platelet factor-3 defect, 5 and medical illness. The local causes can be direct blood vessel injury, 6 pseudoaneurysm, 7 arterial aneurysm, arteriovenous fistula, 8 synovial impingement, or mechanical factors.…”

mentioning

confidence: 99%