Synovial Hypertrophy Causing Recurrent Hemarthrosis after Total Knee Replacement

Abstract

Recurrent hemarthrosis following total knee replacement is relatively uncommon and can result from causes that may not always be easy to diagnose. We report three patients with late-onset recurrent hemarthrosis following total knee replacement due to synovial hypertrophy and impingement, which were successfully treated by embolization.

Causes of failure and etiology of painful primary total knee arthroplasty

“…Hypertension, diabetes mellitus, anticoagulants, trauma, malaligned knees, instability or loose components or pigmented villonodular synovitis [4] may predispose patients to this condition [92]. If a synovial disease or a soft‐tissue impingement is suspected and in the absence of instability or component loosening conservative therapy [61, 92], synoviorthesis [55], embolization [36, 72, 101] or either open [61] or arthroscopic [92] synovectomy may be considered. The latter should be performed by an experienced arthroscopist to avoid damage to the prosthetic components and to guarantee accessibility of the anterior as well as the posterior compartments of the knee (Fig.…”

Recurrent Hemarthrosis Following Total Knee Arthroplasty

“…The pathogenesis of recurrent hemarthrosis is not fully understood and the majority of cases have no obvious etiology. Some accepted explanations leading to the development of a hemarthrosis include an intraoperative vascular injury, the synovial tissue or fat pad being entrapped between the implant surfaces causing repetitive trauma to the hypertrophic vascular synovial tissue, the development of genicular pseudoaneurysms, synovial hyperemia, formation of an arteriovenous fistula, and flexion instability 8,9,11,[16][17][18][19] . Although all 5 of the genicular arteries can be affected, the literature has suggested that there is an increased propensity for involvement of the superior genicular arteries [20][21][22] .…”