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

Kalmár, P.; Leithner, Andreas; Ehall, R; Portugaller, Rupert Horst

doi:10.1007/s11999-015-4476-6

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…The sole major complication occurred in a patient with polycythemia vera and factor VIII deficiency. 10 This patient presented 5 days after his TKA with severe hemarthrosis, and underwent a total of three embolization procedures. After failed intravascular treatment, the patient required five reoperations including repeat wound debridement and repeat closures.…”

Section: Resultsmentioning

confidence: 99%

“…11,[14][15][16][18][19][20]23,24 There were 4 studies that reported using only 1 embolization procedure, [15][16][17]23 in contrast to 4 studies which reported using multiple procedures. 10,11,14,22 The etiology of these discrepancies remains unclear. Potential explanations include differences in technical factors, as well as differences in institutional guidelines regarding the need for repeat embolization.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding this therapy. This meta-analysis aims to assess the rate of symptom relief, the number of embolizations needed to achieve relief, and the rate of complications associated with embolization. Public databases were queried from 1998 until 2018 for TKA-associated recurrent hemarthroses treated with embolization. Eight studies met inclusion and exclusion criteria. Major complications were defined as those requiring readmission or nonelective reoperation; minor complications were defined as those not requiring readmission or reoperation. Pooled statistics were calculated utilizing the method of inverse variance. Fifty-nine patients with a mean follow-up of 30 months (range, 1–50 months) were evaluated. The pooled proportion of patients with symptom improvement following embolization was 86% (95% confidence interval [CI]: 74–93%, I 2: 0%, p = 0.97). The average number of embolization procedures was 1.30 (95% CI: 1.03–1.63, I 2: 0%, p = 0.66). The pooled proportion of patients who required a second embolization procedure was 26% (95% CI: 15–40%, I 2: 0%, p = 0.43), while those requiring three or more procedures was 13% (95% CI: 6–25%, I 2: 0%, p = 0.87). The rate of complications were as follows: any complication – 19% (95% CI: 11–32%, I 2: 0%, p = 0.81); major complications–8% (95% CI: 3–19%, I 2: 0%, p = 0.96); minor complications–18% (95% CI: 10–31%, I 2: 0%, p = 0.79); inguinal hematoma–9% (95% CI: 4–19%, I 2: 0%, p = 1.00); skin necrosis–15% (95% CI: 7–29%, I 2: 0%, p = 0.62); and incision breakdown–7% (95% CI: 3–17%, I 2: 0%, p = 1.00). Previous literature on selective artery embolization following TKA is relatively limited. This meta-analysis supports embolization as a potentially safe and effective treatment for recurrent hemarthroses after TKA. Other correctable causes of recurrent hemarthrosis, such as instability or malalignment, must be diligently ruled out prior to utilizing embolization. Surgeons should be aware of embolization's potential role in the postoperative period following TKA.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…2 Embolization has been described for hemarthrosis related to hypervascularity after arthroplasty. 3,4 However, typically polyvinyl alcohol particles, microspheres, or coils are used. Additionally, the most common indication for intervention is joint hypervascularity or empiric embolization for recurrent iatrogenic hemarthrosis.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Hemarthrosis due to Iatrogenic AVF Treated With Onyx Embolization

Koleilat

Phair

2017

Vasc Endovascular Surg

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A 78-year-old gentleman presented with recurrent symptomatic hemarthrosis after total knee arthroplasty. His workup revealed an iatrogenic arteriovenous fistula (iAVF). The iAVF was embolized with the Onyx Liquid Embolization System with resolution of his symptoms up to 10 months of follow-up. This is the first description to our knowledge of an iatrogenic hemarthrosis after total knee arthroplasty successfully treated with Onyx solution embolization.

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“…9 The complication can cause considerable restriction of movement which can jeopardize the final postoperative result and often mimic the patient's initial presenting complaint. 10 While this presentation is most common in patients with coagulopathy, 11 the etiology of recurrent spontaneous hemarthrosis of the knee is incompletely understood. 12 The most commonly postulated and reported cause is bleeding of hypertrophic vascular synovium, which may be injured via impingement between articulating prosthesis components.…”

Section: Introductionmentioning

confidence: 99%

“…While this presentation is most common in patients with coagulopathy, 11 the etiology of recurrent spontaneous hemarthrosis of the knee is incompletely understood. 12 The most commonly postulated and reported cause is bleeding of hypertrophic vascular synovium, which may be injured via impingement between articulating prosthesis components.…”

Section: Introductionmentioning

confidence: 99%

Genicular Artery Embolization for Recurrent Hemarthrosis of the Knee Following Total Knee Arthroplasty: A Single Centre Experience

et al. 2020

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Purpose: To retrospectively review the safety and efficacy of genicular artery embolization procedures performed at our institution in patients presenting with recurrent knee hemarthrosis following total knee arthroplasty (TKA). Materials and Methods: A total of 13 consecutive patients (average age: 68; range 51-84, 62% female) were identified who underwent 14 genicular artery embolization procedures after presenting with recurrent hemarthrosis after TKA. Patient charts were retrospectively reviewed for demographic information, pre-embolization investigations, and details of embolization procedure including complications, technical success, and clinical success. Each patient had failed initial conservative therapy and all patients had a diagnostic aspiration performed by the referring physician prior to the procedure. The average time between TKA and embolization in our cohort was 21 months. Results: All procedures performed were technically successful, defined as elimination of periprosthetic hypervascular blush. An average of 3.6 genicular vessels were embolized in each patient; 355 to 500 µm polyvinyl alcohol (PVA) particles were used in each case. There were no cases of transient cutaneous ischemia, skin erythema, or skin necrosis. Clinical success was obtained in 85.7% of cases, defined by elimination of the presenting clinical symptoms (knee pain and swelling) during continued follow-up by the referring clinician. Conclusion: Particle embolization is a safe and effective treatment for recurrent hemarthrosis after arthroplasty and our experience suggests that utilizing particle sizes of greater than 300 µm appears to be important in order to avoid cutaneous ischemic complications.

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

Abstract: Background Spontaneous recurrent hemorrhage after arthroplasty of the hip or knee is a rare condition. In patients who do not have coagulopathy, the likeliest etiology for hemarthrosis is hypertrophic vascular synovium.

Cited by 9 publications

References 13 publications

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

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

Recurrent Hemarthrosis due to Iatrogenic AVF Treated With Onyx Embolization

Genicular Artery Embolization for Recurrent Hemarthrosis of the Knee Following Total Knee Arthroplasty: A Single Centre Experience

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