Treatment of Recurrent Hemarthrosis after Total Knee Arthroplasty

Abstract

PurposeThe purpose of this study is to evaluate the incidence and treatment of recurrent hemarthrosis after total knee replacement (TKR).Materials and MethodsAmong a total of 5,510 patients who underwent TKR from March 2000 to October 2016, patients who had two or more bleeding 2 weeks after surgery were studied. Conservative treatments were performed for all cases with symptoms. In patients who did not respond to conservative treatment several times, embolization was performed. We retrospectively evaluated the postoperative bleeding time, bleeding frequency, treatment method, and outcome.ResultsSeventeen (0.3%) of the 5,510 patients developed recurrent hemarthrosis. Bleeding occurred at an average of 2 years 3 months after the operation. Joint aspiration was performed 3.5 times (range, 2 to 10 times) on average, and 14 cases (82.3%) were treated with conservative treatment. In 3 patients with severe bleeding and hemorrhage, embolization was performed.ConclusionsRecurrent hemarthrosis after TKR is a rare disease with a low incidence of 0.3% and usually could be treated by conservative treatment. If recurrences occur repeatedly, embolization through angiography or surgical treatment may be considered, but the results are not satisfactory and careful selection of treatment modalities is warranted.

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

“…1,4,5,10 Although the etiology of hypervascularity and proliferation of synovium has not been clearly elucidated, stimulation of production and activation of inflammatory mediators in the joint result in the occurrence of synovitis and proliferation of blood vessels in the synovium. 3,8 RA is characterized by synovial inflammation and hyperplasia. 12 In the synovial tissues, endothelial activation occurs in synovial microvessels, leading to synovitis and an increase in blood vessels.…”

“…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.…”

“…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. 3,5 In case of failure of embolization, surgical treatment could be performed arthroscopically at first in order to be less invasive compared to open surgery.…”

“…Worland and Jessup 1 reported that recurrent hemarthrosis occurred in 7 (0.5%) of 1400 OA patients after TKA. Yoo et al 3 reported recurrent hemarthrosis in 17 (0.3%) of 5510 OA patients after TKA. Other single cases and case series reported recurrent hemarthrosis after TKA in patients with OA.…”

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

“…This aspiration can confirm the diagnosis and provide relief, though quoted values of relief range from 33 to 80%. 6,8 Because aspiration may not fully resolve a patient's symptoms, further management must be tailored to the potential underlying etiology of the hemarthroses. In the post-TKA setting, arthroscopic 6 and angiographic investigations 11 often reveal a hypertrophic synovium as the underlying mechanism, though other causes have been reported including: arteriovenous fistula of the geniculate vessels, 3 pseudoaneurysm of geniculate vessels, 27 angiosarcoma, 4 impingement of vascular structures under meniscal remnants, 2 and implant malposition.…”