Recurrent Hemarthrosis Following Knee Arthroplasty Treated with Arterial Embolization

Weidner, Zachary; Hamilton, William G.; Smirniotopoulos, John; Bagla, Sandeep

doi:10.1016/j.arth.2015.05.028

Cited by 27 publications

(29 citation statements)

References 9 publications

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“… 2 , 3 , 5 , 10 When hemarthrosis is unresolved conservatively, contrast-enhanced CT, magnetic resonance imaging (MRI) angiography, and Doppler ultrasound could identify vascular anatomy and active bleeding, being less invasive than angiography. 11 , 13 In this case, contrast-enhanced CT was performed, suggesting hypervascularity of the synovium in the superior lateral suprapatellar pouch, and then interventional angiography was performed for diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 90%

“…Various sources of bleeding, including the superior or inferior, lateral or medial geniculate artery branches and other areas, are possible; therefore, thorough examination should be performed. 3,9,13 In addition, hemorrhage occurs intermittently and acutely, and appropriate timing for angiographic therapy might be crucial for the successful treatment of hemarthrosis. 3 If embolization is unsuccessful, repeat attempts should be considered, with careful detection of bleeding sources.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent hemarthrosis after total knee arthroplasty in rheumatoid arthritis successfully treated with selective embolization: A case report

Mammoto

Irie

Takahashi

et al. 2020

SAGE Open Medical Case Reports

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Recurrent hemarthrosis after total knee arthroplasty is a rare complication. This usually occurs in osteoarthritis, but is relatively rare in rheumatoid arthritis. This is a report of recurrent hemarthrosis after total knee arthroplasty in a rheumatoid arthritis patient. An 85-year-old woman with rheumatoid arthritis had received total knee arthroplasty without acute complications. At 6 months after surgery, the first hemarthrosis occurred and an initial conservative treatment failed. Contrast computed tomography showed prominent synovial enhancement in the superior lateral suprapatellar pouch. Selective catheterization revealed an abnormal hyperemic blush supplied from the branches of the superior lateral genicular artery. After embolization with N-butyl-2-cyanoacrylate, abnormal staining of the synovium diminished and knee swelling and pain disappeared without complications. Selective embolization is favorable for successful treatment of recurrent hemarthrosis after total knee arthroplasty in patients with rheumatoid arthritis.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Recurrent hemarthrosis after total knee arthroplasty in rheumatoid arthritis successfully treated with selective embolization: A case report

Mammoto

Irie

Takahashi

et al. 2020

SAGE Open Medical Case Reports

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“…The average timeframe from TKA to treatment for hemarthroses was 28 months (range, 0-216 months). There were 49 patients in whom hemarthrosis was confirmed with diagnostic arthrocentesis 12,14,15,19,20 (►Table 2). There were 45 patients with a reported work-up for bleeding disorders.…”

Section: Resultsmentioning

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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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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“…As the patient continued with recurrent hemarthrosis, an angiography and a selective embolization were performed. Weidner et al[12] reported a case of series with successful results in 12/13 cases (92%) of recurrent hemarthrosis after knee arthroplasty; the only failure was a case of misdiagnosed periprosthetic infection. Guevara et al [13] report a series of cases of 100% success in 10 cases of recurrent hemarthrosis after knee surgery, four of them required a second embolization.…”

Section: Discussionmentioning

confidence: 99%

Successful Selective Embolization for Recurrent Hemarthrosis after Knee Arthroplasty

Barrientos

Barahona

Cermenati

et al. 2019

Case Reports in Orthopedics

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Knee replacement has demonstrated to be a cost-effective treatment for severe knee osteoarthritis. Nevertheless, perioperative complications may occur, including recurrent hemarthrosis reaching an incidence between 0.3 and 1.6%. Success rate after conservative treatment has been reported to be above 80%, but in case of recurrence, computed tomography angiography, magnetic resonance angiography, and Doppler ultrasound have been used to conduct the diagnosis. Arthroscopy or selective embolization is used for treatment depending on the etiology of the bleeding. Open surgery is performed in the rare cases of failure of the above alternatives. The patient consulted seven months after total knee arthroplasty with sudden pain in the medial side of the knee. Infection was ruled out, and arthrocentesis shows hemarthrosis. Successful selective embolization of medial superior and lateral superior genicular artery was performed. After two years, the patients report 92 points in the Forgotten joint score, 0 in Womac pain, 1 in Womac stiffness, and 3 in Womac functional score.

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Recurrent Hemarthrosis Following Knee Arthroplasty Treated with Arterial Embolization

Cited by 27 publications

References 9 publications

Recurrent hemarthrosis after total knee arthroplasty in rheumatoid arthritis successfully treated with selective embolization: A case report

Recurrent hemarthrosis after total knee arthroplasty in rheumatoid arthritis successfully treated with selective embolization: A case report

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

Successful Selective Embolization for Recurrent Hemarthrosis after Knee Arthroplasty

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