Recurrent hemarthrosis after prosthetic knee arthroplasty: Identification of metal particles in the synovial fluid

Kitridou, Rodanthi C.; Schumacher, H. Ralph; Sbarbaro, John L.; Hollander, Joseph Lee; Cutiss, Paul H.; Green, William T.; Laing, Patrick G.; Kitridou, Rodathi C.

doi:10.1002/art.1780120509

Cited by 33 publications

(7 citation statements)

References 11 publications

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“…Recurrent hemarthrosis has been attributed to synovial hyperplasia, 5 vascular abnormality, 6,7 anticoagulant therapy 8,9 and metal particles in the joint. 7 Although reported cases of hemarthrosis after arthroplasty have most often occurred with total knee arthroplasty (TKA), several cases of hemarthrosis after UKA have been described.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Recurrent Hemarthrosis After Unicompartmental Knee Arthroplasty

Asanuma¹,

Itô²,

Ogawa³

et al. 2011

Orthopedics

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“…Als ursgchliche Faktoren werden Gelenkinfektionen (Boitzy u. Zimmermann, 1969;Charnley, 1969;Hessert u. Ruckdeschel, 1970;Gartenmann et al, 1972;Krgmer, 1972;Buchholz, 1973), hyperergische Reaktionen gegeniiber dem eingebrachten Material (Hollander u. Kennedy, 1951;Perger, 1954;Fisher, 1956;Samuels, 1960), Fremdk6rperreaktionen auf abgeriebene Kunststoff-oder Metallteilchen der Endoprothese (Heinrichsen et al, 1947;Lossen, 1952;Debrunner, 1953;Pauwels, 1953;Endler 1953/54;Kiskadden, 1955;D6rf'el u. Legler, 1956;Mittelmeier u. Singer, 1956;Seyfarth, 1956 ;Usher, 1958 ;Contzen, 1962 ;Contzen u. Broghammer, 1964;Meyer, 1964 ;Mittelmeier, 1964;Contzen et al, 1967 ;Willert u. Schreiber, 1969 ;Charnley, 1970 ;Willert u. Puls, 1972), Gewebsschgden durch Korrosionsprodukte des jeweils verwendeten Metalls (,,Metallose") (Nicole, 1947;Gillis, 1958;Bechtol et al, 1959;Ferguson et al, 1960 ;Hicks, 1962 ;Wagner, 1962;Contzen u. Broghammer, 1964;Hicks, 1964;Kitridou et al, 1969;Semlitzsch et al, 1971Semlitzsch et al, , 1972 und schlieBlich gest6rte statische Verhgltnisse (Nicole, 1947 ;Charnley, 1960;Contzen et al, 1967 ;…”

Section: Introductionunclassified

Die Gelenkkapsel nach Alloplastik

Masshoff

Neuhaus-Vogel

1974

Arch orthop Unfall-Chir

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The Articular Capsule after Alloplastic Replacement of the Joint Summary. 1. In 48 cases of alloplastic replacement of the joint, the articular capsule was examined morphologically. Over a period of about 20 years, beginning with the first stage of restitution, the reaction of the capsule was analyzed formally and causally.2. In the first postoperative period, the reactions are typically for the healing of wounds. The new capsule is able to differentiate by functional impulses. Particularly the synovialic structures have similarities to a regenerative product. They are instable and become gradually altered. The corresponding histological manifestations are of an anabiotic and adaptive nature.3. The adaptive anabiotic process in the newly formed joint capsule securing a full function can be exhausted. Accordingly more and more catabioses will take place and the function of the joint will begin to decompensate. In the fibrosed capsule, histolyses, necroses and an abacterial exsudation of fibrin as well as the consecutive organization are caused by biomechanical factors. The resulting process is called "Arthro-Alloplastic-Arthrosis".4. The mechanical factors determine the condition of the capsule. Secondary foreign bodies as attrited prosthetic material, cartilage, bone, or cement maintain inflammatory processes and support in this way the formation of catabioses in the capsule. This development is similar to the common arthrosis.5. Enabled by special investigations the metallosis is discussed. Ceroid and endogenous iron as important staining factors of the capsule were not yet sufficiently noted.Zusammen]assung. 1. Die Gelenkkapsel nach alloplastischem Ersatz des Gelenkes wurde bei 48 Fallen eingehend morphologisch nntersucht und ihr Verhalten vonder ersten Phase der Wiederherstellung fiber einen Zeitraum bis zu rund 20 Jahren formal-und kausalgenetisch analysiert.2. Die Vorggnge in der frfihen postoperativen Phase folgen den 1%egeln der Wundheilung. Die nach der Heilung sich formierende neue Kapsel ist als reparatives Produkt offensichtlich durch funktionelle Einfifisse zu einer gewissen Differenzierung f~hig. Die einem Regenerat vor allem ghnlichen synovialen Strukturen sind instabil und werden allmghlich abgewandelt. Die entsprechenden geweblichen Erscheinungen haben einen anabiotischen Charakter und sind adaptiver Natur.3. Die eine Funktionsfghigkeit gewghrleistenden geweblichen Vorgiinge in der neuen Gelenkkapsel k6nnen sich ersch6pfen, dementsprechend Katabiosen zunehmend Platz greifen und damit die Dekompensation der Gelenkfunktion einleiten. Histolysen und Nekrosen in der

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“…The causes of a recurrent haemarthrosis are not well defined but the most common cause is believed to be the entrapment of either synovial tissue or the fat pad between prosthetic surfaces. 4 Other causes include metalinduced synovitis, [5][6][7][8][9] and abnormal coagulation in the post-operative period from either disease or medication, which may account for approximately one-third of cases reported in the literature. 10 An identifiable cause is not found in more than 50% of cases.…”

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confidence: 99%

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

Malhotra

Bhan

Kiran

2005

The Journal of Bone and Joint Surgery. British volume

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We present seven patients with recurrent haemarthroses after total knee arthroplasty, caused by an inherent platelet function defect. These patients developed painful knee swelling, persistent bleeding and/or wound breakdown, a platelet factor 3 availability defect being identified in all cases. Surgical exploration, with joint debridement, lavage and synovectomy, was performed in four patients who did not improve with conservative therapy. Histopathological examination of synovium revealed a focal synovial reaction with histiocytic infiltration, and occasional foreign-body giant cells. One patient required an early revision because of aseptic loosening of their tibial component. The condition was treated by single-donor platelet transfusions with good results. The diagnosis, management, and relevance of this disorder are discussed.

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Recurrent hemarthrosis after prosthetic knee arthroplasty: Identification of metal particles in the synovial fluid

Cited by 33 publications

References 11 publications

Recurrent Hemarthrosis After Unicompartmental Knee Arthroplasty

Recurrent Hemarthrosis After Unicompartmental Knee Arthroplasty

Die Gelenkkapsel nach Alloplastik

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

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