Recurrent Hemarthrosis After Total Knee Arthroplasty: Evaluation and Treatment

Abstract

Recurrent hemarthrosis (RH) is a rare complication (∼1%) after total knee arthroplasty (TKA). It is a complex and particularly frustrating problem for both patient and surgeon. Typically, patients present several months to years after their index TKA surgery with a painful and swollen joint. Although conservative management may provide temporary relief, the rate of recurrence is high. Despite extensive case series in the literature, no consensus was made on the criteria needed to establish this diagnosis, or how to best provide treatment. Several management strategies have been described for RH, including immobilization, arthroscopic versus open synovectomy, angiographic embolization, and revision arthroplasty. All of these have demonstrated variable effectiveness, with limited evidence for their use in specific situations. This review synthesizes the available literature and suggests an algorithm for the diagnosis and treatment of RH after TKA.

The role of knee arthroscopy in managing common soft-tissue complications after total knee arthroplasty: a retrospective case series study.

“…Local factors include trauma, in amed synovium or vascular anomaly (e.g., arteriovenous malformation) and injury. Cases caused by iatrogenic vascular injury usually present with swelling within 6 months postoperatively [33]. There were no such cases in this study.…”

The role of knee arthroscopy in managing common soft-tissue complications after total knee arthroplasty: a retrospective case series study

“…Iatrogenic factors include an unrecognized vascular injury, implant malposition, loosening or knee instability [30]. Cases caused by vascular injury usually presents swelling within 6 months postoperatively [30]. There were no such cases in this study.…”

“…malaligned implants could lead to asymmetric PE wear and particle generation, causing synovial proliferation, subsequent impingement and bleeding. This is a more chronic process, usually occurring later than one year after TKA [30]. Four patients had wear induced synovitis in the current study.…”

“…Local ones include trauma, in amed synovium (eg, pigmented villonodular synovitis [27], crystalline and in ammatory arthropathies [28], and metal hypersensitivities [29]), or vascular anomaly (eg, arteriovenous malformation). Iatrogenic factors include an unrecognized vascular injury, implant malposition, loosening or knee instability [30]. Cases caused by vascular injury usually presents swelling within 6 months postoperatively [30].…”

Synovitis after Total Knee Arthroplasty: Possible Cause of Residual Postoperative Pain (Preliminary Study)

“…Therefore, it is likely that preoperative synovitis subsides after TKA. However, there are a few reports describing postoperative synovitis in painful TKA such as patella clunk syndrome [3,17] and recurrent hemarthrosis [13,14].…”